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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
- Select -
Student Teacher Supervisor - 8 weeks
Student Teacher Supervisor - 16 weeks
Intern KTIP Supervisor - full year
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
- Select -
Fall
Spring
1st Summer
2nd Summer
Year You Are Enrolled at UK
Course(s) You Are Taking at UK (Include department, number, section, credits, and title.)