Lisd Student Teacher/observer Application Form
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1LISD Student Teacher/Observer Application
APPLICANTS: PLEASE COMPLETE THIS FORM ELECTRONICALLY, PRINT, SIGN AND SUBMIT TO
YOUR PROGRAM DIRECTOR FOR THEIR SIGNATURE
Student Teacher ________ Student Observer_________ Semester_____________________
Name
Street Address
City ST ZIP Code
Phone
E-Mail Address
If LISD Employee, position/campus
Name of University/Program: _____________________________________________________________________
Program Contact Person and Title: _____________________________________________________________
Program Contact Person’s E-Mail Address: ____________________________Phone:_____________________
Area of Certification: __________________________EC-6_______4-8_______8-12______All-Level_________
Date on-line LISD Volunteer Criminal Background Check was submitted: ______________________________
SPECIAL REQUIREMENTS FOR PLACEMENT (Note: Requests for specific teachers or
campuses will not be honored.) If you have specific rotation needs, please list below
Specific requirements: ______________________________________________________________________
_________________________________________________________________________________________
Rotations needed? ONE________ TWO______ If Observing, total number of hours needed ______________
Assignment Start Date: _________________________Assignment Completion Date: ____________________
Location Desired (check one)
Flower Mound/Lewisville/Highland Village ___________The Colony/Frisco ___________Carrollton__________
Date of required LISD Student Teacher Orientation that you will be attending: _________________________
By signing this form, I understand that I am required to attend the LISD Student Teacher Orientation
and the LISD Student Teacher Seminar for the specific semester. (see website for dates)
Student Teacher’s Signature___________________________________________________________
PROGRAM SUPERVISOR’S SIGNATURE (REQUIRED) _______________________________________
For LISD Office Use Only
Date CBC Approved: ____________ Date of Placement: ____________
First Rotation:
Placement: _____________________________________with________________________________
Grade/Subject/Email: _________________________________________________________@lisd.net
Second Rotation, if needed:
Placement: _____________________________________with________________________________
Grade/Subject/Email: _________________________________________________________@lisd.net
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Parent category: Education