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Practicum Placement Survey
*
1.
First/Last Name
(Required.)
*
2.
CWID
(Required.)
*
3.
Tech Email
(Required.)
*
4.
Cell Phone(write like this...000-000-0000)
(Required.)
5.
Certification Area/Major
Early Childhood Education (PK-3)
Elementary Education (1-5)
Music K-12 - Vocal
Secondary Education (6-12) Ag
Secondary Education (6-12) English
Secondary Education (6-12) Mathematics
Secondary Education (6-12) Social Studies
Secondary Education (6-12) Biology
Secondary Education (6-12) Chemistry
Secondary Education (6-12) Physics
Other (please specify)
6.
Practicum Course:
BOTH - Elementary Mathematics AND Science/Social Studies
Elementary Mathematics
Elementary Science/Social Studies
Secondary Practicum
Music Field Experiences
7.
Name of Elementary School(s) you attended.
*
8.
If you have already completed any previous field placements, list here (school/grade). If this is your first math practicum, just state NO PREVIOUS PLACEMENTS.
(Required.)
9.
VERY IMPORTANT (READ DIRECTIONS)
Submit your class schedule here in the comment box so we can finalize your placement. (Ex.: T/R 8-10 class, T/R 2-4 class, M/W/F 9:30-10:45 class.) If ANYTHING changes in this schedule, contact Dr. Vessel (avessel@latech.edu) immediately.
10.
When do you have a block of time daily for practicum. Check all that apply. If you do not have 1 block open all week, you may want to review your current schedule with your advisor to see if any sections can be changed. The BEST schedule is being in the classroom for math or science/social studies DAILY. You are shortchanging yourself if you cannot see the day to day learning taking place in the classroom.
Early Morning 8:00 a.m.- 10:00 a.m.
Mid-Morning 10:00 a.m. - Noon
Early Afternoon Noon - 2:00 p.m.
If you are not available daily for a block of time, please explain here. You may only be assisting with a 1-hour class, but you will need time to get from campus to the school site an back. Keep that time in mind on your calendar.
11.
I understand that in order to have a placement finalized and ready, it is important to check my Tech email regularly, even during break, in case the CRRC needs to reach me. Providing the date of this survey submission is your evidence of understanding this statement.
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
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1911
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1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
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12.
If you commute, we can possibly offer placements closer to home. Please comment what district(s) you would be interested in being placed, and I will follow up with you directly:
Bienville
Bossier
Caddo
Claiborne
DeSoto
Grant
Jackson
Monroe City
Ouachita
Richland
Webster
Winn
13.
Have you completed a Castlebranch background check since August 2026. If not, go to latechcrrc.org and complete today!
Yes
No
Date (Month/Year) of last background check
14.
Do you hold liability insurance? Have you joined APEL for the 2026-2027 academic year? If not, go to latechcrrc.org and join today!
Yes
No
