ࡱ> 8:7#` bjbj5G5G <"W-W- ,      5 DNPPPPPP$hGt9 t     NN p*K! .N0dy ^[Ly y y tt y y y    Aquinas College School of Education Application for Fall 2008 Directed Student Teaching The Aquinas College School of Education has my permission to search ICHAT (Internet Criminal History Access Tool) for any felony or misdemeanor convictions on my record. I understand that the information provided in this release form and received from the ICHAT report is confidential. I understand that I may be dismissed from the School of Education if I falsify any information regarding my background check during my time in the teacher certification program at Aquinas College. Signature: ________________________________________ Date: ________________________  The following information is required in order to conduct an ICHAT search: Last Name: _ FORMTEXT      ________ First Name: _ FORMTEXT      ____ Middle Initial: _ FORMTEXT      _ Race:  FORMCHECKBOX  White  FORMCHECKBOX  Black  FORMCHECKBOX  Asian or Pacific Islander  FORMCHECKBOX American Indian or Alaskan Native  FORMCHECKB#$&6>YZ[]^c @ B M N v w | }     ļq#jhwHhwH>*UmHnHujhwHhwH>*UhwHhwH>*jhwHhwH>*Uhl.hjhAUhNLhh/{hrhh6CJaJh$gCJaJhhrCJaJhAhhACJaJhhCJaJ,$%&Z[\]^A B C $a$gd     4 6 8 : N P R \ ^ ` b f h    ( * F H J |jhwHUjlhwHUjhwHUhwHjhwHUhuphjhwHhwH>*U#jhwHhwH>*UmHnHujhwHhwH>*UhwHhwH>*jhwHhwH>*UhNLhl.0   "$&BDFHPVXtvxzԶ奝{奝#jhwHhwH>*UmHnHuj$hwHhwH>*UhwHhwH>*jhwHhwH>*UhNLhjhwHUj<hwHUh/{hl.jhwHUUhupjhwHUjThwHUhwH.OX  Other Sex:  FORMCHECKBOX  Male  FORMCHECKBOX  Female Month of Birth: _ FORMTEXT      ______ Day of Birth: __ FORMTEXT      _ Year of Birth: _ FORMTEXT      _ Other Last Name:_ _ FORMTEXT      _________________________ Oth tvx|~ $&(*FHJL`bdnprv "$8:<FHJͭͩͩ͗͏jhwHhwH>*UhwHhup>*UjhwHhwH>*Uhl.hj hwHhwH>*UhwHhwH>*hNLhup#jhwHhwH>*UmHnHujhwHhwH>*UjhwHhwH>*U1er First Name: __ FORMTEXT      _________________________ Other Middle Initial: _ FORMTEXT      ________________________ hup#jhwHhwH>*UmHnHujhwHhwH>*UjhhwHhwH>*U:PP&P:pA+o/ =!"#$% Dd!<P  3 3"((tDText1tDText2tDText3tDeCheck2tDeCheck1tDeCheck3tDeCheck4tDeCheck5tDeCheck6tDeCheck7tDText4tDText5tDText6tDText7tDText8tDText9<@< NormalCJ_HmH sH tH DAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List l$@l t"Envelope Address!@ &+D/^@ CJ^JaJhF%@F t"Envelope Return CJ^JhHH A Balloon TextCJOJQJ^JaJ"$%&Z[\]^ABCbcLMFG0@0@0@0@0@0@0@0@0@0@00@0@0@0@0@0@0@0@0@0@0@0@0@0@00@00@00@00@0@00@00@00      $06MY_jz *3C^jp%+^jpFFFG G G G G G G FFFFFF8@0(  B S  ?Text1Text2Text3Check2Check1Check3Check4Check5Check6Check7Text4Text5Text6Text7Text8Text9$Nk4^_ 7`{ +Dq,q R> lcR> lcR> cR> ,cR> cR> cR> ,cR> ,cR> c0087??=*urn:schemas-microsoft-com:office:smarttags PlaceType=*urn:schemas-microsoft-com:office:smarttags PlaceName9 *urn:schemas-microsoft-com:office:smarttagsplace 0t  6:333MNvw|}"#$789::;<KLM`aaj{ +3D\]^qttwx,\]^qQ_a@^mX xDAfU H& 9vA+QN=NrjNLgG^Nb Ye r t"7%<';,p,l.c#1~4(5^695[98V:>L?A}fA[BDGDERFX#GgEG\IJ)/JJJwK6N_KO+RVTmTHVH{XY;$[[vazb]-d}e[e?fXBf$g1j+mYmoA+o/oapupr)_ruLu\hvwy Dz/{2{s|F}G}y}! d0fXga a`'6 &}/'d-n%!44:{Mw[ e7O/qXCJn_$^6LU\& B%?aiQ2#>,o$-Y;UV:EkYyoKF#,E3> E,=-AyRtbL&YSl-{&*%Bs$IGn& wH~ t7RH370m1ho@ }4@ UnknownGz Times New Roman5Symbol3& z Arial5& zaTahoma"h^:fg:fL붦  Y24d2HX)?wH25Application for Spring 2008 Directed Student TeachingENGLISUSENGLISUSOh+'0 , @L l x  8Application for Spring 2008 Directed Student Teaching ENGLISUS ICHAT.dot ENGLISUS3Microsoft Office Word@V@ؗx@d^J!@;K!՜.+,0( hp  Aquinas College  6Application for Spring 2008 Directed Student Teaching Title  !"#$%&()*+,-.01234569Root Entry Fp6-K!;Data 1TableWordDocument<"SummaryInformation('DocumentSummaryInformation8/CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q