Student Teaching and Clinical Studies

Contact Us

Dept. of Student Teaching and Clinical Experiences
2418 Buzzard Hall
Eastern Illinois University
Charleston, IL 61920
Weekday Office Hours
7:30 a.m. - 4:30 p.m.
Phone: 217-581-2620
Fax: 217-581-7915

Cooperating Teacher Stipend Verification Form

Teachers who are supervising EIU student teachers need to complete this form to receive stipends and tuition waivers.

Semester *

Indicate whether you are supervising a student teacher in fall or spring semester.
Student Teacher's Name * First Last
Enter the student teacher's name here.
Student Teacher's E-Number *

Enter the student teacher's EIU E-Number here.
Student Teacher's Subject/Grade Level *

Enter the subject(s) and/or grade(s) the student teacher is teaching with you.
No. Weeks *

Indicate the number of weeks the student teacher is working under your supervision.
EIU Coordinator's Name *

Include the name of the EIU coordinator who is working with you and the student teacher.
Your Name * First Last
Enter your name here as the cooperating teacher who will receive a stipend/tuition waiver.
Your EIU E-Number
(If you do not have one, you may skip this line.)

Enter your EIU E-Number, if you have one. If you do not have one, you may skip this line.
Your Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Enter your address.
Your Race/Ethnicity (for demographic data collection purposes only)

Enter your race/ethnicity. This information is collected only for demographic data collection purposes.
School Name *

Enter the name of your school.
Principal's Name * First Last
Enter the name of your principal.
School Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Enter the address of your school.
Tuition Waivers
At this time, I intend to use the tuition waivers awarded me this semester for serving as a Cooperating Teacher.

*If you mark "no" and you change your plans, please contact the Student Teaching Office, at 217-581-2620. NOTE: A waiver is good for one calendar year. Keep a copy for your record and return this original to the University Coordinator with whom you are working. Stipends are $75 (prorated for partial assignments) and are paid directly to the cooperating teacher, unless mandated differently according to Contract with the District. * Yes No
Indicate whether you intend to use the tuition waivers awarded to you for this semester's supervision.
COOPERATING TEACHER: Please verify that all information is accurate and complete by checking the "Information is correct" box below. Information is correct
You must check this box to verify that all information is correct. If you have questions, contact the Student Teaching office at 217-581-2620.