Semester FALL ISU Teacher Education Course Information Department Course Name School/Agency Information School/Agency Name Address Year SPRING Course Number Section Number City School / Cecilia J. Lauby Teacher Education Center / / /
Position
administrator for approval signature / **Driver / Teacher / / district administrator / Illinois State department coordinator / Candidate Information Name / Teacher Information Teacher Name / /
Self-Placement Form for Clinical Experiences Present this form to a district administrator when seeking a clinical experience that is not prearranged by an Illinois State department coordinator or instructor. Self-placem