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Site Supervisor Application

Application to be a site supervisor for the Library Science Program at Eastern Kentucky University

Name: *

School and District: *

Mailing Address: *

Contact Number: *

You can include both office and cell phone

Email Address: *

Educational and Certification Information

From which university did you receive your Master’s Degree?: *

Please include the area of concentration for this degree.

From which school did you receive your School Library Media Certification?: *

From which university did you receive your Bachelor’s Degree?: *

Please include your major field of study.

How many years of experience do you have as a School Library Media Specialist/Teacher Librarian?: *

1-3 Years

3-5 Years

More than 5

Please give an overview of your job responsibilities and experience: *

Why would you like to be a site supervisor?: *

Practicum Applicant Name: *

Leave this field blank:

Part A:

Basic Responsibilities of a Cooperating Teacher/University...

EKU’s College of Education future educators may be learning from home due to the COVID-19...