Cooperating Teacher Stipend Verification Form

Cooperating Teacher Stipend Verification Form

Teachers who are supervising EIU student teachers need to complete this form to receive stipends and tuition waivers. FOR SPRING 2014 SUPERVISION, PLEASE SUBMIT THIS FORM BY APRIL 1, 2014.

  • Indicate whether you are supervising a student teacher in fall or spring semester.

  • Enter the student teacher's name here.

  • Enter the student teacher's EIU E-Number here.

  • Enter the subject(s) and/or grade(s) the student teacher is teaching with you.

  • Indicate the number of weeks the student teacher is working under your supervision.

  • Include the name of the EIU coordinator who is working with you and the student teacher.

  • Enter your name here as the cooperating teacher who will receive a stipend/tuition waiver.

  • Enter your EIU E-Number, if you have one. If you do not have one, you may skip this line.

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    Enter your address.

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

  • Enter the name of your school.

  • Enter the name of your principal.

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    Enter the address of your school.

  • Indicate whether you intend to use the tuition waivers awarded to you for this semester's supervision.

  • 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.