Petition for Student Teaching If you are in EDYS 300 and planning to student teach, please fill out this form. It will help us gather initial information for your placement, state reporting and test match results, conduct the state required background check and help us for to be sure that you are on track to meet all the requirements for teacher certification. All fields marked with asterisk (*) are required. header field Personal Information name required text field Legal Name* Legal name (First, Last, M.I.) previous_names textarea field Previous Name(s) localcampus_address required text field Local/Campus Address* email_address required e-mail address field Email address* student_id required text field Student ID#* birthdate required date field Birthdate* xx/xx/xxxx race required text field Race* current_legal_sex_marker required text field current gender* gender_assigned_at_birth text field Other legal sex The State of Wisconsin Department of Public Instruction uses a combination of name and gender/legal sex to match your record at Beloit College with your testing records. If you have, or previously had, a legal sex different from your gender identity, please include it here. It will be used for matching purposes only home_address required textarea field Home Address* personal_email required text field Personal Email* phone required text field Phone #* horizontal_line field header field Academic Information majors required textarea field Major(s)* minors required textarea field Minor(s)* certification_area required text field Certification Area* horizontal_line field header field Student Teaching Intentions student_teaching_semester required checkbox field Student Teaching Semester* Fall Spring (petition only, contact department chair term required checkbox field Term* 7th term 9th term Spring term (upon petition only) content_level required checkbox field Grade level* Elementary Secondary K-12 (arts, theater, language) content_area text field Content Area required file attachment field Unofficial Transcript* (50 MB max) edys_major_gpa required text field Major GPA* GPA below a 3.0 may require additional Praxis testing composite_gpa required text field Composite GPA* A GPA below a 3.0 may require additional Praxis testing do_you_have_any_edys_courses_t textarea field Do you have any EDYS courses that have a final grade below a B? If yes, Please list below. horizontal_line field header field Background Check Information have_you_ever_been_disciplined text field Have you ever been disciplined academically, or by the Beloit College judiciary board anytime time at Beloit College? please_select required checkbox field Please Select*If yes, please attach a description/documentation No Yes file attachment field File Attachement (50 MB max) have_you_ever_been_convicted_o text field Have you ever been convicted of any criminal offense (including criminal traffic matters, but not general traffic violations) in any jurisdiction? please_select required checkbox field Please select*If yes, attach an explanation No Yes Felony Misdemeanor file attachment field File attachment (50 MB max) is_any_criminal_charge_or_inve text field Is any criminal charge or investigation pending against you in any jurisdiction? please_select required checkbox field Please select*If yes, attach and explanation No Yes file attachment field File attachment (50 MB max) i_certify_that_all_information required checkbox field I certify that all information included in this application is truthful. I understand that I have a continuing obligation to report any changes to the answers in this application to the appropriate chair of the education program (college or conservatory). I also understand that this application will be reviewed and that Beloit College can conduct a criminal background check prior to placing me for student teaching. I hereby give permission for that check.* Yes No horizontal_line field Link (required)