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Curriculum Worksheet for Initial Teaching License

This worksheet is completed at the beginning of the semester you student teach. Review this worksheet with your advisor and obtain signature from the Licensure Program Coordinator prior to submitting to Diane Copple, Lommen 214a. The list of Licensure Program Coordinators is found on page 3 of this document.

In completing this curriculum worksheet you are indicating:  You have intent to apply for a teaching license (online in MN, OR with another state).  You have completed OR have current enrollment in all requirements for licensure (as noted on your DARS).  You have a student teaching placement noted in DIARY (this must be printed out from DIARY and attached to this Curriculum Worksheet). Directions for printing are found on page 4.  Basic skills testing is noted on your DARS (MTLE Math, Reading & Writing, ACT Plus Writing OR SAT). If basic skills testing is NOT noted on DARS, you must attach documentation to this Curriculum Worksheet.

Please Complete

Name:______Last First Middle/Birth Name/Other

Phone Number: ______E-mail______

I will be graduating at the end of: ______Fall ______Spring ______Summer

I have completed the requirements for the following licensure/endorsements: Titles noted on page two of this document. Licensure Title Major Minor Other Teaching Coordinator Signature Date Level 2

Required Testing Basic Skills Testing (MTLE Math, MTLE Content Test MTLE Pedagogy Test Reading, Writing, ACT Plus Writing OR SAT) ____ Passed ____ Passed ____ Passed ____ Failed ____ Failed ____ Failed ____ Scheduled to ____ Scheduled to ____ Scheduled to retake______take/retake take/retake ______

Student Teaching Experience Placement information must be printed from DIARY and attached to this worksheet. License Grade Level(s) Number of Weeks

In Progress Coursework Course Title Credits Term Example: ED 451S Student Teaching: Secondary 12 Spring 2016

The Curriculum Worksheet along with a copy of your DARS and the DIARY Printout of your student teaching placement is submitted to Diane Copple, Lommen 214a once signed by the Licensure Program Coordinator. Licensure/Endorsement Titles and Teaching Levels Academic & Behavioral Strategist (ABS) (09) Music: Instrumental and Classroom (09) Autism Spectrum Disorders (ASD) (13) Grad Music: Vocal and Classroom (09) Chemistry (12) Physical Education (09) Communication Arts/Literature (CA/L) (11) Physical/Health Disabilities (PHD) (13) Grad Developmental Disabilities (DD) (09) Physics (12) Early Childhood Education (02) Reading (09) Grad Early Childhood Special Education (ECSE) (01) Grad Science (10) Earth Science (12) Social Studies (11) Elementary Education (07) Visual Arts (09) Emotional Behavioral Disorders (EBD) (09) World Languages-Spanish (09) English as a Second Langue (ESL) (09) Endorsements Health Education (11) Developmental/Adapted Physical Education (08) Learning Disabilities (LD) (09) Middle Level Communication Arts & Literature (04 3

Life Science (12) Middle Level Math (04) Mathematics (11) Middle Level Science (04)

Licensure Program Coordinators Communication Arts & Literature Dr. Elizabeth Kirchoff [email protected] ESL Dr. Linda Houts-Smith [email protected] Early Childhood Dr. Layna Cole [email protected] Elementary Education Dr. John Benson [email protected] Health, Physical Education, D/APE Dr. Julie Knutson [email protected] Mathematics Dr. Tim Harms [email protected] Chemistry Dr. Richard Lahti [email protected] Earth/Space Science Dr. Russ Colson [email protected] Life Science Dr. Alison Wallace [email protected] Physics Dr. Steve Lindaas [email protected] Social Studies Dr. Steve Hoffbeck [email protected] Special Education, ABS Dr. Keri DeSutter [email protected] Special Education, Twin Cities Dr. Sue Severson [email protected] Special Education, Graduate Dr. Ximena Suarez-Sousa [email protected] Music Dr. Monte Grise [email protected] Visual Arts Brad Bachmeier [email protected] World Languages: Spanish Dr. John Hall [email protected]

Teaching Levels 01 Birth through Age 6 09 Grades K-12 03 Kindergarten 10 Grades 5-8 04 Endorsement: Grades 5-8 11 Grades 5-12 07 Elementary: Grades K-6 12 Secondary: Grades 9-12 08 Prekindergarten-Grade 12 13 Birth-Grade 12

Please see next page for instructions on printing student teaching placement from DIARY. 4

Directions for Printing Student Teaching Placement from DIARY

Sign into DIARY. This will take you to your dashboard page.

Click on “Placements”.

Then click on “Print Placement Report”. (if your timing session has expired, you will have to login with your starid and password again.) 5

The print option will appear. You can select the printer to be used to print.

Print this report and attach it to the Curriculum Worksheet.

Submit pages 1 & 2 of the Curriculum Worksheet AND the student teaching report from DIARY to Diane Copple, Lommen 241a.