Junior II Placement Application

Name

First

Last

UIN

TAMU Email

Phone Number

Course/Section #

TEFB 371-501 (Field Day W)

TEFB 371-502 (Field Day M)

TEFB 371-503 (Field Day T)

TEFB 371-506 (Field Day F)

Primary Certification

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

Please explain any extenuating circumstances that might affect your placement.

Clinical 2 Placement Application