Following is a list of information you will need to complete the Elementary STAR Form. You may want to print this and fill in the information to facilitate your work on the computer.

You must have a valid TB test on record with the Office of Field Experiences in Bluemont 244 in order to student teach.

If you need to make changes to the Statement of Disclosure (Blue Form) related to arrests or criminal prosecution this should be done prior to completing the STAR form. You can update this form in Bluemont Hall 244.

All students must have a documented Blood Born Pathogens completion form on file in the Office of Field Experiences prior to Student Teaching. This is generally accomplished in your early field experience course. If you are unsure if you have met this requirement you will need to check with our office in 244.

All elementary and secondary education students must show proof of American Red Cross or equivalent (e.g. American Health Association) certification in both CPR and First Aid in order to be eligible to student teach. Proof of completion must be provided to the Field Experiences Office (BH 244). (Eligibility for Speech Pathology graduate students will be verified through the Speech Path. Department.) Local training is available through Lafene / American Heart Association (785-532-6595), the American Red Cross (785-537-2180), or the University For Man (UFM).

Section A: Request Information

Please note, this section requests information about your preference for a student teaching placement. In no way does the information recorded in this section guarantee you a placement in a specific school or with a specific district. This information is collected for the purpose of providing the Office of Field Experiences with additional information which will better enable a successful placement. A number of factors are considered when placing student interns. These factors include, but are not limited to, academic performance, demonstrated professional dispositions, availability, and supervision limitations. While we do take your preference into consideration during the process we are not limited to these preferences.

Grade Level Preferences: 1st, 2nd, 3rd Preference

District Name Preferences: 1st, 2nd, 3rd Preference

Ft. Riley/Junction City, Manhattan/Ogden, Riley County, Topeka PDS, Kansas City PDS

Section B: Personal Information

This section requests information which will help the Office of Field Experiences make decisions regarding your placement for the internship. Please note, failure to disclose information regarding each of these policies could lead to your removal from a placement or from the student internship during the semester. Please read carefully.

  • All elementary student intern placements are made in districts which have an establish Professional Development School relationship with the College of Education at Kansas State University.
  • A student may not be placed as a student intern in a school or district in which they previously attended.
  • Student interns will not be placed in schools in which they were previously employed or in schools or districts in which a close family relative is employed.
  • Student interns will not be placed in schools in which they have family members currently enrolled as students.
  • All placements are made in consultation with the Block C instructors, Clinical Instructors, school-based administrators, and appropriate cooperating teachers candidates. The final decision regarding placements resides with the Director of Field Experiences.

Do you have transportation available? Yes / No

If you have school age children or relatives, please give their grade level(s) and the school(s) they attend (List one child per line followed by a comma):

Are you or your family members related to or are friends with any employee(s) of the district(s) in which you have applied to student teach? Yes / No

If you have answered 'Yes' to the previous question, please explain.

Please enter any special request below:

In case of an emergency while student teaching, notify:

City, St, Zip:  
School activities in high school:
List maximum of 5

School activities in college:
List maximum of 5

Special recognition or honors:
List maximum of 5

List maximum of 5

School activities in which experience is desired:

Most internet browsers do not support spell checking. Instructions on how to cut and paste from a wordprocessing program are as follows.
  1. Type the information to be transferred on a word processor and save the file.
  2. Spell check and read for correct grammar.
  3. Open typed file.
  4. Highlight information you want to transfer to the form you are filling out.
  5. Copy highlighted information.
  6. Paste information into the STAR form.
  7. Read over pasted information to check accuracy prior to submitting the form.

Student Teacher Statement of Introduction

Write an introduction of yourself to your cooperating teacher. Following are some suggested items you might wish to include in your statement:

  • a brief statement of your home and community background
  • the name and approximate enrollment of the high school you attended
  • when you decided to become a teacher and why you chose your teaching concentration
  • any previous experiences with children or young adults
  • any particular unit or activity you would like to teach if possible
  • your future goals or plans
  • any other information which you think will help your cooperating teacher know you better

Your Statement of Introduction must fit within the window provided without scrolling (approx. 350 words). Essays which exceed this limit will be cropped when sent to requested schools.