Intent for Clinical Participation
Be sure to submit this form prior to the deadline for your Residency I / Residency II /
or Student Teaching as indicated in emails to you.
Please Complete All Fields.
I am planning to participate in:
Your Proposed Plan
I plan on doing Residency I, Residency II, or Student Teaching in
Licensure Area (Teaching Field)
Please enter emergency contact information during your clinical experience:
List any pertinent information that you feel is important for the TTU Office of Teacher Education to consider when
making your placement for your clinical experience (i.e. carpooling with another candidate, health concerns or limitations, pregnancy, etc.)
Please choose two school systems that you would like to complete your Residency I or Student Teaching in.
Your choices will be considered but not guaranteed. Since you will remain in your Residency I
location throughout your Residency II semester, please leave these boxes blank if you are planning
your Residency II placement.