Clinical Experience II: Cooperating Teacher Training Confirmation

Clinical Experience II: 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 for those cooperating teachers supervising teacher candidates for Clinical Experience II.

  • Please use the email associated with the school/organization for which you work.
  • Please indicate the school/organization through which you are employed.
  • Please indicate the date that all training requirements were completed.
    MM slash DD slash YYYY
  • 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.
  • By checking the following boxes, I am confirming that I have completed in full the general 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.
  • By checking the following boxes, I am confirming that I have completed in full the co-teaching training required by the Kentucky Educational Professional Standards Board (EPSB), 16 KAR 5:040, and the Boyce College Educator Preparation Program (EPP). I understand that all items listed below must be complete in order to be eligible to serve as a cooperating teacher who is directly supervising a student teacher.
  • If you have served as a supervising teacher in the past and have already completed the W-9 for Boyce College, no resubmission is necessary unless your information has changed. However, payment cannot be processed for your stipend if no form is on file. This form must be submitted in PDF format.
    Accepted file types: pdf, Max. file size: 8 MB.
  • If you have served as a supervising teacher in the past and have already completed the New Vendor Application for Boyce College, no resubmission is necessary unless your information has changed. However, payment cannot be processed for your stipend if no form is on file. This form must be submitted in PDF format.
    Accepted file types: pdf, Max. file size: 8 MB.
  • 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.