Following is a list of information you will need to complete the Secondary 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.

High School Attended:

Student Teaching Grade Level Preferences: 6-8 or 9-12

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

Junction City/Ft. Riley, Manhattan/Ogden, Riley County, Rock Creek, Wamego, and others.

Art, Music, or Modern Language

If you have Art, Music, or Modern Language as your major teaching field and will do part of your student teaching in an elementary school, complete the following:

Elementary School District and Name:

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.

Do you have transportation available? Yes or No

If you have school age children, please give their grade level(s) and the school(s) they attend:

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 or No, Explain

Special request:

In case of emergency while student teaching, notify: Name, Address, City, St, Zip, Phone

The following information is to provide the cooperating district and teacher background information about you.
List a maximum of 5 for each category.

School activities in high school:

School activities in college:

Special recognition or honors:


School activities in which experience is desired:

Student Teacher Statement of Introduction

Most internet browsers do not support spell checking. Typing your essay in Microsoft Word or another word processor and then cutting and pasting to the form is suggested.
Write an introduction of yourself to your cooperating teacher. Your Statement of Introduction must be less than 350 words (approx.). Following are some suggested items you might wish to include in your statement.