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Cultural Immersion Projects
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How to apply

Cultural Project Data Form

( Education 1044 )

Please fill out compeletely

Your e-mail Address (e.g., smith@indiana.edu):

University (e.g., Indiana University):

Select the project(s) in which you are interested (you may check more than one):


















Your First Name:
Your Middle Name:
Your Last Name:
Current Phone or Cell Number:
Gender
Full Current Address(Street):
City, State, Zip code:
Date of Birth(DD/MM/YYYY):
Do you want to student teach in a:

If Elementary, what grade do you desire as a student teaching assignment?:
If Secondary, in which content area(s) are you seeking certification?

Be specific, especially Social Studies majors; e.g., "U.S. History"

Major: Minor:
Other Special Programs:
Are you in Teaching All Learners (elementary and special education)?
Are you in any other special program (e.g., COT or others)?
Please Identify:
Are you planning to seek any license additions at this time (e.g., Reading, ESL) or are there any other considerations relative to your student teaching?
In what academic year do you plan to student teach? NOTE: ALL Projects are full semester assignments.





Personal interests, hobbies, skills:
Have you filled out an "official" application for student teaching?
I will get my degree from: (check one)



List any personal conditions that may have a bearing on your student teaching assignment.
Parents'/Guardians' name:
Parents'/Guardians' Phone:
Parents'/Guardians' address (Street):
Parents'/Guardians' City, State, Zip code:
When you student teach, will you be:
Will you be paying:
Please be sure that you understand that this is a full semester project.
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