Cooperating Teacher 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 $250.00.
Cooperating Teacher Info
Required Cooperating Teacher Last Name
(Maximum characters allowed: 50)
Cooperating Teacher First Name
(Maximum characters allowed: 50)
Required Social Security #
(Maximum characters allowed: 50)
Required Street Address
(Maximum characters allowed: 10,000)
Required City
(Maximum characters allowed: 10,000)
Required State
(Maximum characters allowed: 10,000)
Required Zip Code
(Maximum characters allowed: 10,000)
Required Phone #
Include extension if applicable
(Maximum characters allowed: 10,000)
Required E-mail Address
(Maximum characters allowed: 100)
Required Year
(Maximum characters allowed: 50)
Required Semester
Teacher Candidate Info
Required Student Name
(Maximum characters allowed: 50)
Required Student ID#
(Maximum characters allowed: 50)
Required Please check one:
Required Endorsement Area

Required Electronic Signature
The following is a description of the documentation and expertise required of a Regis University Cooperating Teacher. 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. Ensure adequate continuity, class contact and supervision of the Teacher Candidate. The Teacher Candidate is a part of the teaching team, and should not be considered a replacement for the regular teacher. In your absence, if the Teacher Candidate does not have a substitute teaching license there must be a substitute teacher on duty.

2. Define the Teacher Candidate’s role in terms of duties and responsibilities:

a. Schedule a conference with the Teacher Candidate early in the semester to clarify the role of the Teacher Candidate in the given situation.
b. Provide opportunity for the Teacher Candidate to observe the kinds of methods which are appropriate to the teaching profession.
c. Help the Teacher Candidate become acquainted with the policies and procedures applicable to students and teachers in the school building.
d. Clarify the Teacher Candidate’s responsibilities with respect to making lesson plans, securing and organizing appropriate materials, and other necessary activities.
e. Clarify the Teacher Candidate’s responsibilities for non-teaching tasks, such as cafeteria or hall duty, extracurricular events, and other activities.
f. Advise the Teacher Candidate, well in advance, anytime that he/she will be expected to teach a lesson or unit.
g. Negotiate at the initial conference, with the Regis Supervisor and the Teacher Candidate a timeline which indicates when the Teacher Candidate will assume full teaching responsibilities.
h. Assist the Teacher Candidate with the design and the implementation of a unit plan in order to successfully complete the Colorado/Wyoming Work Sample requirement.

3. When concerns arise regarding the Teacher Candidate’s ability, please contact the Regis Supervisor immediately.

4. Complete a mid-term and final Discussion and Evaluation form with the Teacher Candidate and the Regis Supervisor. Compare the results of this form with the student’s self-appraisal.

I have read and understand the requirements of being a Regis University Cooperating Teacher.

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
(Maximum characters allowed: 100)
(Maximum characters allowed: 100)
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