Supervising and Resource Teacher Tuition Waiver

Your First Name

Your Middle Name

Your Last Name

Your Student ID

Your Street Address

Your City

Your State

Your Zip

Your Email

Your Phone

School District Where You Teach

School Name Where You Teach

School Phone

Your Role

Supervising Beginning and Ending Dates

First Name of Student or Intern

Last Name of Student or Intern

Student Teacher's University

Student University Contact Person

Term You Are Enrolled at UK

Year You Are Enrolled at UK

Course(s) You Are Taking at UK (Include department, number, section, credits, and title.)

Communications