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Form B: Confirmation of Practice Teaching or B.Ed. PRACTICUM Dates

Name:

Email Address:

Telephone Number:

Status with International TESOL:

Confirmed Starting Date:

TRANSPORTATION

Airline and flight number:

Arrival date and time in Mexico/China:

Travel Agent and phone number:

INSURANCE

Name of Insurance Company:

Policy Number:

PERSONAL DATA

Address:

Height:

Weight:

Color of hair:

Color of eyes:

Distinguishing characteristics (ie, tattoos, scars):

Emergency phone number 1):

Emergency phone number 2):

Arrival time and date at teaching site:

Departure time and date from teaching site:

Destination upon departure:

Special health needs:


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