Screen Reader Mode Icon

Question Title

* 1. First/Last Name

Question Title

* 2. CWID

Question Title

* 3. Tech Email

Question Title

* 4. Cell Phone(write like this...000-000-0000)

Question Title

* 5. Certification Area/Major

Question Title

* 6. Name of Course(s) You Need A School Placement

Question Title

* 7. Name of Schools (elementary, middle, high) you attended.

Question Title

* 8. List ALL previous placements (course, grade, school, district) or NA if this is your first placement.

Examples:
Reading - 3rd - Smith - _____ Elementary School - Lincoln Parish
Math - 5th - Jackson - Crawford Elementary - Bienville Parish

Question Title

* 9. If you commute, please note if you would prefer a placement in another town besides Ruston. We love giving you opportunities in other districts! If you live in Ruston, your placement will be made in Lincoln Parish Schools (just write LINCOLN in the box.)

Question Title

* 10. SCHEDULE: 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. NOTE: You MUST have an opening daily in the am (8-10, 10-12) or pm (12-2) if you are taking a practica course.

Question Title

* 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

T