Baity Hall

Missouri Valley College

Application for Clinical Experience

First Name:
Middle Initial:
Last Name:
Email:
Home Address:
City:
State:
Zip Code:
Local Address:
City:
State:
Zip Code:
Emergency Contact:
Phone:


Expected Clinical Experience Semester and Year:
Elementary
(If pursuing Elementary Education track) I will enroll in:
ED 350 Elementary Clinical Experience
ED 330 Arithmetic for Teachers
ED 331 Teaching Reading Elementary School
ED 332 Teaching Elementary Social Studies
ED 333 Teaching Elementary Science

Secondary
Subject:
I will enroll in:
ED 352 Secondary Clinical Experience

Middle School Social Studies
(If pursuing Middle School Social Studies track) I will enroll in:
ED 351 Middle School Clinical Experience
ED 341 Developing Person

SKILLS AND CHARACTERISTICS:
Indicate special skills, talents, and personal qualities which will be of value to you in teaching (music, crafts, sports, etc.)
EXPERIENCES:
Indicate past experience that you think might contribute to your effectiveness as a teacher and aid you in understanding children.
ACTIVITES ENGTAGED IN AND HONORS EARNED:
High School:
College:
TEACHING AREA:
What attracted you to teaching as a profession?
Why did you select your particular teaching field?
Please write a brief autobiographical sketch in the space below. Indicate why you believe you will be an affective teacher:
What do you anticipate learning as a result of your Clinical Experience?
ORGANIZATIONAL MEMBERSHIP:
Professional organizations:
Social organizations:
Other:
HOBBIES:
Student Signature
Date