Clinical Practice Cooperating TeacherInterest FormPlease complete this survey if you are interested in hosting a Cal Poly Teacher Candidatefor Clinical Experience during the 2018-19 school year.

We are looking for Cooperating Teachers that will welcome a Teacher Candidate and support them ina Co-Teaching Environment! Cal Poly offers Teacher Preparation Programs in Multiple Subjects,Single Subjects (Biology, Chemistry, English, Geosciences Mathematics, Physics, Social Sciences,and World Languages), and Special Education services.

There are 14 questions in this survey.

Content Area: *! Choose one of the following answersPlease choose only one of the following:

Multiple Subjects (Elementary)

Single Subjects - Biology

Single Subjects - Chemistry

Single Subjects - English

Single Subjects - Geosciences

Single Subjects - Mathematics

Single Subjects - Physics

Single Subjects - Social Sciences

Special Education - Mild/Moderate Disabilities

If you are interested in hosting a Teacher Candidate in Agriculture, please contact Mr. GregBeard: gbeard@calpoly.edu

Single Subject credential in World Languages is not available for the 2018-19 academic year.For questions, please contact Nancy Stauch: nstauch@calpoly.edu.

Above you will see an overview of the structure of the clinicalpractice experience. Are you interested in hosting a teacher candidate for the 2018-19 school year?

*Only answer this question if the following conditions are met:Answer was 'Single Subjects - Biology' or 'Single Subjects - Chemistry' or 'Single Subjects -English' or 'Single Subjects - Geosciences' or 'Single Subjects - Mathematics' or 'SingleSubjects - Physics' or 'Single Subjects - Social Sciences' at question '1 [Content]' (ContentArea:)

Please choose only one of the following:

Yes

No

Teacher candidates are placed in one classroom for ClinicalPractice I & II, then are placed in a new classroom for ClinicalPractice III. New teacher candidates are admitted every

quarter, therefore placements of all types are needed eachquarter.Please indicate which type of placement(s) you would prefer:Only answer this question if the following conditions are met:Answer was 'Multiple Subjects (Elementary)' at question '1 [Content]' (Content Area:)

Please choose the appropriate response for each item:

Fall Winter Spring

CP I & II (Choosepreferred firstquarter)

CP III

Placement Type Preference:*Only answer this question if the following conditions are met:Answer was 'Special Education - Mild/Moderate Disabilities' at question '1 [Content]' (ContentArea:)

! Check all that applyPlease choose all that apply:

Minor Placement (1 Day/Week Fall and Winter Quarters)

Major Placement (1 Day/ Week Fall, 2 Days/Week Winter, 5 Days/Week Spring Quarter)

Cooperating Teacher Info *

School *! Choose one of the following answersPlease choose only one of the following:

Flamson MS

Arroyo Grande HS

Atascadero Fine Arts Academy

Atascadero HS

Atascadero JHS

Baywood El

Bishop's Peak El

Cambria Grammar

Cayucos El

Central Coast New Tech

CL Smith El

Dana El

Daniel Lewis MS

Del Mar El

Dorothea Lange El

El Camino JHS

Fairgrove El

Fesler JHS

Harloe El

Jimenez El

Judkins MS

Kermit McKenzie JHS

Laguna MS

Lakeview JHS

Lillian Larsen El

Lompoc HS

Los Osos MS

Mary Buren El

Mesa MS

Miller

Monarch Grove El

Morro Bay HS

Nipomo El

Nipomo HS

Oakley

Ocean View El

Oceano El

Orcutt Academy Charter HS

Pacheco El

Paso Robles HS

Pine Grove

Pioneer Valley HS

Rice El

Righetti HS

San Benito El

San Gabriel El

Sanchez El

Santa Maria HS

Sinsheimer El

SLO HS

Templeton El

Templeton HS

Vineyard El

Winifred Pifer El

Other

Please list the courses you plan to teach in the 2018-19 schoolyear: *Only answer this question if the following conditions are met:Answer was 'Single Subjects - Biology' or 'Single Subjects - Chemistry' or 'Single Subjects -Social Sciences' or 'Single Subjects - Physics' or 'Single Subjects - English' or 'Single Subjects- Geosciences' or 'Single Subjects - Mathematics' at question '1 [Content]' (Content Area:)

Please write your answer here:

Grade Level: *Only answer this question if the following conditions are met:Answer was 'Multiple Subjects (Elementary)' at question '1 [Content]' (Content Area:)

! Choose one of the following answersPlease choose only one of the following:

TK

K

1

2

3

4

5

6

Other

Types of instructional practices used in your classroom:Only answer this question if the following conditions are met:Answer was 'Multiple Subjects (Elementary)' at question '1 [Content]' (Content Area:)

! Check all that applyPlease choose all that apply:

Small Group/Differentiated Instruction

Cooperative Learning/Group Work

Project-Based/Inquiry-Based Learning

Integrated/Designated ELD

Subject Matter Integration

SPED Push-In Model

Other:

What specialization is listed on your credential: *Only answer this question if the following conditions are met:Answer was 'Special Education - Mild/Moderate Disabilities' at question '1 [Content]' (ContentArea:)

! Choose one of the following answersPlease choose only one of the following:

Mild/Moderate Disabilities

Moderate/Severe Disabilities

Deaf and Hard of Hearing

Visual Impairments

Physical and Health Impairments

Early Childhood Special Education

Grade Bands: *Only answer this question if the following conditions are met:Answer was 'Special Education - Mild/Moderate Disabilities' at question '1 [Content]' (ContentArea:)

Please write your answer here:

Service Delivery Model (Ex. Resource, Special Day, LearningCenter, etc.): *Only answer this question if the following conditions are met:Answer was 'Special Education - Mild/Moderate Disabilities' at question '1 [Content]' (ContentArea:)

Please write your answer here:

Why are you interested in hosting a Cal Poly TeacherCandidate? *Please write your answer here:

The Commission on Teacher Credentialing and Cal PolySchool of Education require that Cooperating Teachers meetthe following requirements: · Clear credential in the content area they are teaching · Minimum of 3 years of teaching experience · Knowledge of the California Standards for the TeachingProfession, as well as current trends and best practices ineducation.· Ability to model the following practices:

Instructional Planning: how the teacher organizes thecontent to learn and designs the instructionAssessment: ability to continuously monitor studentlearningDifferentiation of Instruction: teacher creates multiplepaths so that students with different learning needs meetthe instructional objectivesStudent Engagement: teacher can ensure and elicitstudent participationClassroom Environment: teacher has a welcoming andorganized classroom environment and behaviormanagement systemReflective Practitioner: teacher can examine ownpractice and speak openly about strengths andweaknessesCommitment to Continuous Learning: commitment toattaining new knowledge and skillsCollaboration: engages in mutual examination of teachingand learningGrowth Mindset: recognizes students’ and families’strengths and helps the feel they can contribute to theirown educational growth

Professionalism: displays the highest standards ofintegrity and ethical conductTeacher Leadership: demonstrates active involvement inschool and community

Do you feel able to meet the requirements as statedabove?*! Choose one of the following answersPlease choose only one of the following:

Y: Yes

N: No

U: Uncertain

Click here for more information on Cal Poly’s support and partnership with CooperatingTeachers! (https://soe.calpoly.edu/ctresources)

Thank you for your interest in serving the SOE as a Cooperating Teacher!

Submit your survey.Thank you for completing this survey.