Intern Application Form

Seidel School of Education and Professional Studies
Internship Application
Deadline April 1, 2008

Please complete the following:

GullNet ID	First Name	Last Name

Permanent street address	Permanent Phone
	() -

City	State	Zip

SU email address	Major	Elementary/ Early Childhood Special interest areas
		Use control-click to select more than one interest area
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. Please add a justification about why you should be placed there.

Briefly describe for the mentor teacher and the school principal how teachers
insure 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.

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