Clinical 3 Placement Application

First Name

Last Name

UIN

TAMU Email

Phone

Primary Certification

BILINGUAL EC-6 (*BIED students only)

EC-6 Generalist

4-8 Math/Science

4-8 Language Arts/Social Studies

4-8 English

7-12 ELAR

7-12 History

7-12 Social Studies

Other

Other Certification

Select your course/section:

Elementary - RDNG 467-501 (Field Days W/R)

Elementary - RDNG 467-502 (Field Days W/R)

Elementary - RDNG 467-503 (Field Days M/T)

Elementary - RDNG 467-504 (Field Days M/T)

Middle Grades (Math/Sci) - RDNG 490-501 (Field Days W/R)

Middle Grades (LA/SS) - RDNG 490-502 (Field Days M/T)

Secondary (ELAR SEED Minors only) - RDNG 490-502 (Field Day M or T)

Secondary (Hist/SS SEED Minors only) - MEFB 450-502 (Field Day M or T)

Semester Clinical 2 was completed:

Assigned Clinical 2 Campus:

Grade level of Clinical 2 placement:

Content area of Clinical 2 placement:

Will you have transportation to your assigned campus?

Yes

No

How do you plan to get to your assigned campus (carpool, bus, etc.)?

If you have a relative or child at an area school, please list the campus.

Emergency Contact Name

Emergency Contact Phone Number

Explain any extenuating circumstances that might affect your placement.

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