Preservice Internship Application Form

Preservice Internship Placement Application

Teacher Education Program
Graduate School of Education and Counseling

Internship assignments are made cooperatively by college and school district personnel. The information you provide here will assist teacher education faculty in matching you with specific mentors in K-12 schools. We attempt to honor student preferences, but school district needs and availability of mentors take priority. Please be aware that this form, along with your resume, will be sent to school districts for placement purposes.

Please use the "tab" key to jump between fields on this form. Pressing "enter" may cause the form to submit before you are finished.

Name (last, first, middle)
Former Name (if applicable)
Current Mailing Address
Phone (home)
Phone (work)
Phone (cell)
Email
Fax
Permanent Home Address
High School Attended (include city and state)
Authorization: Admission to the preservice intern program is a two-step process requiring (1) acceptance by the Graduate School of Education and Counseling and (2) acceptance by a school district. Please review and sign statement below. By typing my full name into the box, I hereby grant permission for the contents of my application file to be reviewed by authorized school district personnel involved in the intern selection process.
Describe the school or community you would like to work in:
What should we know about you to support our selection of a mentor who will support your learning and teaching?
What hobbies, interests, free-time activities do you enjoy?
Early Childhood/Elementary Applicant: If you have a strong preference for either the younger learners or intermediate age learners, please indicate here and state a rationale.
Middle School/High School Applicant: If you have a strong preference for placement (Middle School or High School), please indicate here and state a rationale.

Preservice Internship Placement Application

Teacher Education ProgramGraduate School of Education and Counseling

Teacher Education Program
Graduate School of Education and Counseling