Medina City Schools Field Placement Request Form
Please complete this form for student teacher, practicum, and observation placements within Medina City Schools.  While we make every effort to accommodate field placements, it is not always possible to secure placements for all requests.  Completion of this form does not ensure placement.  Please allow up to 48 hours to receive a confirmation of form receipt and up to two weeks to find a cooperating teacher.  

Medina City Schools Field Placement Process:

1). Submit request form and answer all questions providing as much detail as possible.
2). You will receive a confirmation of form receipt within 48 hours.
3). The MCS Department of Instruction will coordinate a placement and confirm placement within two weeks of the initial request. An email contact for the cooperating teacher will be provided in the email confirmation.
4). The field placement candidate is expected to make contact with his or her cooperating teacher at least two weeks prior to the first day of the experience.
5). Important: On the first day of the experience, the field placement candidate must report to the main office and sign-in. The candidate MUST provide the building secretary with a photo ID and recent documentation of his or her FBI/BCI background check. These forms MUST be presented to the building secretary on the first day of the field placement experience.
6). The field placement candidate will be provided a Medina City Schools email account and access to our Learning Management System, Blackboard.

Sign in to Google to save your progress. Learn more
Name of student teacher, practicum student, or student seeking observation. *
College or university student attends. *
Name and title of person making the request. *
This contact information will be used while your request is processed.  Ex. Julie Dawes, Placement Coordinator
Email address of person making the request. *
This contact information will be used while your request is processed.  
Field experience candidate email address
This placement is for
Clear selection
Licensure area
Experience start date
MM
/
DD
/
YYYY
Experience end date
MM
/
DD
/
YYYY
Important placement information. *
Please include all necessary placement information including grade levels, subject area, and time commitment.  
Preferred building and/or cooperating teacher.
Preferences are not guaranteed.
Please read the MCS Technology Acceptable Use Policy (AUP) linked below (only for student teacher requests). Indicate that you agree to the terms below. This will provide you access to district technology.  *Field Coordinators: Please print a copy of the AUP for the student.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Medina City School District.

Does this form look suspicious? Report