Seidel School of Education and Professional Studies
Internship Application
Deadline April 1, 2009

Please complete the following:

GullCard  # First Name Last Name
Permanent phone number Permanent street address
() -
City State Zip

SU email address Major Elementary/ Early Childhood Special interest areas


 Ethnicity   Gender   

Minor (if appropriate) Select Degree

 SU Advisor

Anticipated Graduation PRAXIS II Completion High School Attended


Transfer Student Associate for Arts in Teaching Transfer Institution

Other Educational Experience   Related Work Experience

Internship placements are part of the 100-Day Internship. All internships must occur
in a Regional Professional Development School.

Click here to view a list of SU's Regional Professional Development School partners:
Regional Professional Development Schools

County Preference   Do you have your own transportation?
Have you applied for an international field experience?  

Special Circumstances: Please include any special circumstances that you may have with respect to transportation, subject matter, etc.

Are you requesting a school where a relative is employed?  If so please provide the following information:  Relative's name,your relationship to them, and the school name.  Add a justification about why you should be placed there.

Briefly describe for the mentor teacher and the school principal how teachers
ensure that all students learn.
(Your response will be sent to the mentor teacher and school principal)
  (Write this essay in Word and copy it into this form)

Scroll up to review your responses. Make any changes necessary
before clicking on the Submit button. 

Print out the next page, have it signed.  Please bring your TB test results
and your signed application to the Field Experience Office for processing. 

NOTE:  Make sure you remove the header and footer codes in the page setup before you print your application--

Created by Carol Wood
Copyright 2008 [Salisbury University Seidel School of Education and Professional Studies]
.All rights reserved.
Revised: 07/29/2009