University Supervisor Stipend Form

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General Info
Please submit this form by April 15th in the spring semester and November 15th in the fall semester. The stipend amount is $600.00.
University Supervisor Info
Required University Supervisor Last Name
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University Supervisor First Name
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Required Social Security #
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Required Street Address
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Required City
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Required State
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Required Zip Code
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Required Phone #
Include extension if applicable
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Required E-mail Address
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Required Semester
Required Year
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Teacher Candidate Info
Required Student Name
(Maximum characters allowed: 50)
Required Student ID#
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Required Electronic Signature
The following is a description of your responsibilities as a Teacher Candidate supervisor for Regis University. To ensure prompt processing of your stipend check, please complete this form and submit it no later than April 15th for the spring semester and November 15th for the fall semester.

1. During the experience, you must visit the Teacher Candidate a minimum number of seven (7) times for a full placement; eight (8) times for a split placement; and four (4) times for an abbreviated placement that has been previously approved by their Regis faculty advisor. This includes an initial interview or pre-conference, a number of observations, and a final interview or post-conference.

2. Please review the student’s journal, which is completed by the student and submitted to you along with supporting lesson plans. At the initial meeting, ask the student to keep these in the classroom so that they are available when you visit.

3. A videotape of a lesson by the Teacher Candidate is an optional activity during the student teaching experience. We do recommend it as a useful learning tool and a record of the student’s first classroom experience as a teacher.

4. The form entitled Regis University Student Teaching Discussion/Evaluation will be used as a discussion tool and as an evaluation tool both at mid-term and for the final evaluation. The student should be encouraged to use it as a self-evaluation tool prior to both the mid-term meeting and the final evaluation meeting.

5. At the end of the student teaching experience, collect the final evaluation form (which should also have the mid-term evaluation on it), add it to your observation forms and your letter of recommendation and give them to the student at your last meeting. The student will be responsible for bringing all final documentation to their Regis faculty advisor.

6. As the Regis University supervising teacher, you have the responsibility for overseeing the quality of the placement experience for the Teacher Candidate. Your primary responsibility is to provide constructive feedback to the Teacher Candidate in order to facilitate his/her professional development.

7. Remind the cooperating teacher that in his/her absence and if the Teacher Candidate does not hold a substitute license, there MUST be a substitute teacher in the classroom.

I have read and understand the requirements of being a University Supervisor for Regis University.

Upon submission of this form all parties agree to the terms as outlined herein and/or on the attached documents. Regis University will pay the agreed upon stipend after the grade recommendation is submitted to Regis University. The Payee agrees to a contract that is temporary in nature; thus, it carries no fringe benefits and no guarantee of a continuation of any role for the Payee after this particular course is complete.
Electronic Signature of Applicant
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