University of Pittsburgh at Greensburg

Department of Education

Application for Pre-Student Teaching and Student Teaching

Dear Teacher Candidate: This application must be fully completed for you to be placed in pre-student teaching and student teaching. If any of the benchmarks have not been completed or are left blank, you are at risk of not having your application accepted.

All paperwork must be submitted to Jane Hoch, Cassell Hall 211.

Name Enter Name	PeopleSoft # Enter People Soft ID Number
Current Address Enter your current address, including street, city, state, and zip code
Home Address (including street address, city, state, and zip) Enter permanent address, including street, city, state, and zip code
Phone Enter cell phone number	e. Mail Enter Pitt e. Mail address
☐	Early Childhood	☐	Special Education
☐	Secondary Education	Content Area Enter content area
Current GPA	Enter current GPA

☐	Completion of a minimum of 84 credits (including ____ in major for SEC students)
☐	3.0 minimum overall GPA by the start of student teaching
☐	2.8 minimum overall GPA by the start of pre-student teaching
☐	Required hours in the field (ECE – 130 hours (minimum) | Sec – 100 hours (minimum)
☐	Achievement of acceptable dispositions

Updated Clearances, trainings, and TB test:

Scan QR code for directions on applying for clearances.

NOTE:

A total of 6 documents MUST be submitted:

3 clearances (PA Criminal, Child Abuse, and FBI/Fingerprint)

2 trainings (Mandated Reporter and Professional Ethics)

1 TB test

You may need to register/complete the Professional Ethics training (Act 126, Part 2) using a non-Pitt email address.

Submit renewed documents to the Pitt-Greensburg education office by July 1st for pre-student teaching during the fall semester OR November 1st for pre-student teaching in the spring semester.

School district from which you graduated high school: Enter school district you attended
School districts in which you have relatives or children: (check all that apply.)
☐	Baldwin	☐	Gateway	☐	Laurel Highlands	☐	Southmoreland
☐	Belle Vernon	☐	Greater Latrobe	☐	Ligonier Valley	☐	Yough
☐	Burrell	☐	Greensburg Salem	☐	Mount Pleasant
☐	Connellsville	☐	Hempfield	☐	Norwin
☐	Derry	☐	Jeannette	☐	Penn Trafford
☐	Franklin Regional	☐	Kiski	☐	Plum

Requested School District in which to pre-student teach and student teach: (Choose 5 and rank in order of preference with 1 being the most desired.)

Rank	Baldwin	Rank	Gateway	Rank	Laurel Highlands	Rank	Southmoreland
Rank	Belle Vernon	Rank	Greater Latrobe	Rank	Ligonier Valley	Rank	Yough
Rank	Burrell	Rank	Greensburg Salem	Rank	Mount Pleasant
Rank	Connellsville	Rank	Hempfield	Rank	Norwin
Rank	Derry	Rank	Jeannette	Rank	Penn Trafford
Rank	Franklin Regional	Rank	Kiski	Rank	Plum

Specify the grade level most desired: (Choose 2, and rank in order of preference with 1 being the most desired.)
Secondary	☐	Middle School Rank Choice	PK-4	☐	K-1 Rank Choice
☐	High School Rank Choice	☐	2-4 Rank Choice

I plan to begin my pre-student teaching during the	Select term	of year	Enter year
with the expectation that I begin student teaching the following semester.

☐	By submitting this form, I agree that all information submitted in this form is complete and accurate. I understand that I am not permitted to request a placement change after submission and I understand my degree audit prior to being placed at a site for pre-student teaching.

Students will be notified of their placement. Students are NOT to contact schools or teachers for placements. Do NOT request to be in the district from which you graduated. Placement requests will be attempted, but not guaranteed.