Student Application for New York City Student Teaching

THE STATE UNIVERSITY OF NEW YORK - URBAN TEACHER EDUCATION CENTER
		
	New York City Department of Education Offices
	65 Court Street, Room 405, Brooklyn, New York 11201
	
	Directions:  Students requesting student teaching assignments in New York City must
	complete this form.  Please return the application package to your campus
	Director of Student Teaching. Please write legibly.


1. Last Name:  ___________________________	2. First Name:  ____________________________

3. Social Security:  __ __ __ /__ __ / __ __ __ __	4. DOB:  ___________/__________/__________

5. College / University:  _____________________	6. Expected Graduation:  Mo.______ Year______

7. Campus Address:

	Street: ____________________________________________________________________________

	City: ___________________________________  State: __________  Zip Code: _________________

8. Contact Phone: __ __ __/__ __ __ / __ __ __ __	9. E-mail: ________________________________

10. Preferred Method of Contact: 
	
	E-mail ____  Home Phone ____  Cell Phone____  Postal-mail ___

11. Student Teaching Level:

	Early Childhood ____  Childhood ____  Middle Childhood ____  Adolescence ____            

	Specialty Subject (PreK- 12) ____

12. Certification Area: ____________________________________________________________________

13. Student Teaching Term:
	
	Fall _______ Spring _______ of   Year ___________

14. Date(s), if any, you must be on campus during your student teaching term:

   _____________________________________________________________________________________


15. Permanent Address: 

	Street: ______________________________________________________________________________
           
	City: _____________________________________   State: ______________Zip Code: _____________
           
	Phone: __ __/__ __ __ / __ __ __ __

16. Are you applying for housing through SUTEC?
           
	Yes ____  No ____

17. If you are not applying for housing, where do you plan to reside while student teaching in New York City?  
        
	Provide your address:
          
	Street: ______________________________________________________________________________

	City: ______________________________________  State:_________  Zip Code: _________________
           
	Phone: __ __ __/__ __ __ /__ __ __ ___
										

18. If you have a preference for a placement site, please mark at least two of the following boroughs:

	Brooklyn ____   Bronx ____   Manhattan ____   Queens ____   Staten Island ____
          
	Reason(s): __________________________________________________________________________

19. The Director of Student Teaching on your campus is: ________________________________________

	Phone: __ __ __/__ __ __ / __ __ __ ___    	E-mail: ____________________________________

20. Resume and Personal Essay:

	1) SUTEC requires each applicant to submit his/her resume with a short personal essay of no 
	more than 500 words explaining his/her reasons for "Choosing Student Teaching in New York City."
	Your essay should focus on one or two reasons.  
                
	Note:  If your campus requires you to submit an education statement, you may submit that 
	statement in lieu of "Choosing Student Teaching in New York City."



If you have any questions regarding student teaching in a New York City school please contact the 
SUTEC office at 718-935-5515 or send an e-mail to Natalie.Lukas@suny.edu