Cooperating Teacher Training Confirmation Form

Cooperating Teacher Training Confirmation

This form is to indicate the completion of all requirements for cooperating teacher training required by 16 KAR 5:040 and the Boyce College Educator Preparation Program.

Name*
Prefix First Middle Last Suffix
Email*
Please use the email associated with the school/organization for which you work.
Enter Email Confirm Email
Phone*
School/Organization*
Please indicate the school/organization through which you are employed.
Date of Training Completion*
Please indicate the date that all training requirements were completed.
MM slash DD slash YYYY
Do Any of These Apply to You?*
Certificates & Licenses*
According to 16 KAR 5:040 Section 1, all cooperating teachers are required to hold valid teaching certificates or licenses for all grade levels and subjects taught. Please list certificates and licenses as well as their expiration dates below.
Training Requirements*
By checking the following boxes, I am confirming that I have completed in full the cooperating teacher training required by 16 KAR 5:040 and the Boyce College Educator Preparation Program. I understand that all items listed below must be complete in order to be eligible to serve as a cooperating teacher.
- I meet all requirements of a cooperating teacher as outlined in 16 KAR 5:040 Section 1, including holding a valid teaching certificate or license for all grade levels/subjects taught and having at least three years of teaching experience as a certified teacher.
- I received either a print copy or electronic copy of the Boyce College EPP Clinical Experience Handbook.
- I received an electronic copy of all forms, rubrics, and training materials pertinent to my role as a cooperating teacher for the Boyce College EPP.
- I received necessary contact information for the Boyce College EPP chair, the Clinical Experience and Placements Coordinator, and the EPP course professor(s) in the event of a problem or concern with the teacher candidate(s) placed in my classroom.
- I reviewed all information on the Cooperating Teacher Resources Page of the Boyce College website.
- I watched the Clinical Experience Overview Video on the Cooperating Teacher Resources Page of the Boyce College website in its entirety.
- I either (1) attended the ZOOM cooperating teacher training hosted by the Boyce College EPP Clinical Experience and Placements Coordinator or (2) read through all forms, rubrics, and training materials sent to me in their entirety.
- I received the name(s) and contact information for the teacher candidate(s) assigned to my classroom.
Electronic Signature & Submission*
I have agreed to submit this confirmation of training by electronic means. By completing this form and typing my name below, I certify that I understand the questions and statements on this form and that my answers are correct and complete to the best of my knowledge.
- By checking this box and typing my name below, I am electronically signing my cooperating teacher training confirmation form.
Name*
Prefix First Middle Last Suffix
CAPTCHA

Cooperating Teacher Training Confirmation

Are you ready to become a pastor, counselor, or church leader who is Trusted for Truth?