SOUTHERN CONNECTICUT STATE UNIVERSITY
Personal and Professional Data
for School Media Specialist Student Teaching Applicants

Directions: Three copies to be filled out. Must be typed or word processed.

 

Name:

 

Social Security Number:

 

Date of Birth:

 

Home Address:

 

Home Phone Number:

 

Email Address:

 

 

1. Check off the professional courses you have taken. If not taken at SCSU, list both course title and number and where the course was taken.

 

_____ EDU 566 Media Utilization and Curriculum
. .
_____ PSY 370 Educational Psychology _____ PSY 371 Educational Psychology
. .
_____ SED 481 Teaching Exceptional Children in
Elementary Education Classroom		 _____ SED 482 Teaching Exceptional Children in
Secondary Education Classroom
. .
_____ Ed.F. 520 Child in American Culture _____ Ed.F. 521 Contemporary Philosophy and Education
_____ Ed.F. 522 Education in Other Nations _____ Ed.F. 523 Social Foundations of Educaton
_____ Ed.F. 524 History of Western Education _____ PHI 370 Philosophy of Education
. .
_____ American History (covering 50 years) _____ General Education (Liberal Arts)

 

 

2. Check off the courses you have taken in the school media specialist concentration.

 

_____ LSI 501 Intro to Info Sci & Tech _____ LSC 503 Foundations of Librarianship
_____ LSC 504 Reference Info Res & Services _____ LSC 506 Info Anal & Organization
_____ LSI 580 Evaluation & Research _____ LSC 521 School Lib Media Center
. .
_____ LSC 510 Mat & Serv for Children _____ LSC 525 Mat & Serv for Adolescents
.. ..
_____ ITC 500 Inst Tech Foundations _____ ITC 570 Utilizing Inst Media
_____ ITC 571 Design Inst Software _____ ITC 572 Adm Inst Media Services
_____ ITC 575 Inst Design Principles _____ ITC 576 Design Corp Train Environ
_____ ITC 578 Single Camera TV _____ ITC 673 TV Studio Teaching
_____ LSI 592 Multimedia Interface Design
. .
_____ LSC 510 Mat & Serv for Children _____ LSC 525 Mat & Serv for Adolescents
_____ LSC 523 Online Information Retrieval _____ LSC 527 Lib Serv for Special Groups
_____ LSC 547 Library Automation _____ LSC 551 Digital Libraries
_____ LSC 620 Storytelling Institute _____ LSC 630 Storytelling Applications
_____ ITC 572 Adm Inst Media Services _____ ITC 575 Inst Design Principles
_____ ITC 683 Dist Learning Institute

 

 

3. Experience in working with children and youth.

 

 

 

4. Previous work experience.

 

 

 

5. Participation in extra-curricular activities.

 

 

 

6. Talents, skills or interests which may be assets in teaching.

 

 

 

7. Travel experience.

 

 

 

8. Reasons you want to be a school media specialist.

 

 

 

Return this completed form and the Student Teaching Application to the Library School office
at least six months prior to the term in which you wish to student teach.