Junior II Placement Application

Name*

First Last

UIN*

TAMU Email*

Phone Number*

Course/Section #

Primary Certification*

Will you have transportation to your assigned campus?*

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.

Comments

This field is for validation purposes and should be left unchanged.

Clinical 2 Placement Application