Clinical Teacher Information Survey

First Name

Last Name

Best Phone Number

Physical Address during student teaching

City/Town

State/Province

ZIP/Postal Code

Briefly tell me about your home life - where are you from, sixe of family, what they do, etc.

What motivates you?

Who motivates or inspires you?

What or who makes you angry or gets you really upset or embarrassed?

What has been your biggest challenge or worry in your educational journey so far toward getting your teaching degree?

How would others describe you?

How would you describe yourself?

What are your top three strengths?

What are 3 things you feel as a student teacher you will need to work on?

In what ways can I/we help you to be successful?

What is your biggest concern/worry regarding the teaching field experience?

What is your career goal or where would you like to see yourself in five years?

How interested are you in pursuing your Master's Degree on a scale of 1-6, with 6 being most interested.

If your number is on the low end, what would it take for you to become more interested in the advantages of a Master's Degree?