APPLICATION FOR STUDENT TEACHING AND INTERNSHIPS SUPERVISION
Requests for student teaching placements and for other field placements come from Anna Maria, Assumption College, Becker College, Worcester State University, and other schools at various times throughout the school year. In order to make better decisions and handle these placement requests in a timely manner we are implementing this procedure. Teachers interested in supervising any type of field placement must fill out the form below. Once approved by central office and building principal, applications will be kept and used to match interns with placements. Once matches are made teachers will be notified.

Criteria for Leicester teacher or administrator to be a supervising practitioner:

 Interest by educator
 3 full years of experience under the appropriate initial or professional license for endorsement being sought be the candidate,
 Summative performance rating of “Proficient” or “Exemplary” as defined by the DESE new evaluation tool (2016)
 Approval of building administrator

Teachers are instructed to cut and paste this form into a Word document then print or email a copy to the Curriculum Director.


Name

School

Grade or Subject Taught

Years in this Placement

Please describe prior experience supervising student teachers or other field placements.

List all such experiences you’ve had over the past 5 years. Include dates:

Please describe any professional development you have participated in over the past 3 years, excluding professional development provided by our district:

Briefly explain why you wish to supervise a pre-service teacher:

What skills or dispositions do you have that make you suited for this work?

ADOPTED: June 3, 2014