Personal Data Form

Click here for a Word document containing the Personal Data Form.

The information provided on this form and a copy of your transcript may be shared with cooperating teachers and other professionals involved in the student teaching placement process.

The student provides the following information:

  1. General Data
    1. First name, last name, and initials
    2. Home address: street, city, state, and zip code
    3. Local address: street, city, state, and zip code
    4. Home and local telephone numbers
    5. Email address
    6. Age
    7. Gender
    8. Intended semester of graduation
    9. Intended semester for student teaching
  2. Educational Information
    1. Name of high school attended
    2. Year of graduate from high school
    3. College(s) attended (other than Penn State)
    4. Current major
    5. Area of concentration
    6. Majors enrolled in before Education (if any)
    7. Honors received
  3. Personal Experience
    1. List and describe experiences you have had with children and youth other than course-related field experiences.
    2. List and describe your professional experiences with children (teachers' aide, substitute, course-related field experiences, etc.)
    3. List and briefly summarize other work experiences you have had.
    4. List extra or co-curricular activities in which you have been engaged; indicate your special interests and talents.
  4. Professional Knowledge
    1. Identify (no acronyms, please) the professional organizations with which you are affiliated and the nature of your participation.
    2. Describe five (5) techniques which teachers can employ to enhance student learning.
  5. Why did you choose teaching as your profession? In a short essay, explain what led to your decision and why you believe that you can be an effective instructional leader.
  6. (Non-Pennsylvania assignments only) In a short essay, discuss your reasons for choosing this site for student teaching. Include your expectations for your personal and professional growth.