New York City College of Technology - Career & Technology Teacher Education

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Application for EDU 4871 Student Teaching

Semester *

Date of Birth *

YYYY

Name (last name, first name) *

You must provide your full SS# and complete home address on this form. Both are required to register you on the NYCDOE PETS system for internship or student teaching.

Social Security # *

CUNY EMPID *

Home Address (Street, Apt #, City/State, Zip Code) *

Phone Numbers (home, work, cell) *

Email Address *

What is your teaching subject? *

Do you have any special knowledge, skills, or experience expertise in your teaching subject that you would like the school of your placement to know about? List your special expertise below.

List the school or schools where you completed your internship course (EDU 3681) *

Are you currently employed in a school? If yes, give name of school below.

School where you will perform the student teaching activities (if known):

School Name

School Address (Street, City/State, Zip Code)

School Phone Number

Building Principal's Name

Supervisor's Name

Your trade/teaching subject

I understand that approval to register for EDU 4871 is granted by the Department after faculty review and subject to the successful completion of ALL PREREQUISITE COURSES with an overall grade point average (GPA) of 2.50 or higher. I also understand that I must register for the co-requisite course EDU 4600. (Please Sign & Date below) *

Submit completed Student Teaching Application form by email to Ruben Rodriguez at rurodriguez@citytech.cuny.edu no later than TUESDAY, DECEMBER 8th 2020. Applications WILL NOT be accepted after this date.

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