I, _____________________________________(your name) have practiced safe,

responsible, legal and ethical use of technology and have compiled with
___________________________________________s (name of school/district)
acceptable use policies including fair-use and copyright guidelines and internet-use
protection policies while completing my clinical experiences and/or student teaching

_____________________________
(Your signature)

__________________
(Date)

______________________________
(Cooperating teachers signature)

__________________
(Date)