Internship Request Form

Internship Request Form

Please complete this form if you are interested in completing a required internship (i.e., field work, student teaching, practicum) or student study in the Passaic Public Schools
Please review our

Passaic Public Schools Internship Protocol
Name*

First NameLast Name
Name

First NameLast Name
Email Address*

Confirmation Email
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Select Semester *

Sping 2025Fall 2025Spring 2026
Which best describe your placement*

Senior level field workStudent TeachingUndergraduate practicumSGMH GrantOther
Select all that apply to your preferred placement*

ArtBusinessCareer and Technical EducationChild Study Team - LDTCChild Study Team - PsychologistChild Study Team - Social WorkerChild Study Team - Speech PathologistELL/Bilingual TeacherFamily and Consumer ScienceHealthLanguage Arts/LiteracyLDTC - PreschoolMathematicsMusicNaval SciencePhysical EducationPsychologist - Pre SchoolReading InterventionistSchool CounselorSchool Library Media SpecialistScienceSocial StudiesSocial Worker - Pre SchoolSocial Worker - School basedSpecial Education TeacherTeacher Grade 9-12Teacher Grades 6-8Teacher Grades K-5Teacher PreschoolTheater ArtsWorld Language
Preferred Grade Level*
Do you have a preferred PPS school?*
School Status*

FreshmanSophomoreJuniorSeniorGraduate Student
What are your career goals?*
What are the university expectations of the Passaic Public Schools as a district?*

0/200
What are the university expectations of the cooperating teacher/team member? *

0/200
Describe your experience (internship, employment or otherwise) with urban communities:*

0/200
What are the university expectations of the host school? *

0/200
Check all certifications you are CURRENTLY pursuing*

Not Currently CertifiedAmerican Sign LanguageAppliance RepairArabicArtAssociate School Library Media SpecialistBilingual EducationBiological ScienceBlind or Visually ImpairedChemistryChineseCoop. Ed. CoordinatorCoop. Ed. Coordinator/Hazardous OccupationsDanceDeaf or Hard of Hearing: Oral/Aural CommunicationDeaf or Hard of Hearing: Sign Language CommunicationDirector of School Counseling ServicesDriver EducationEarth ScienceEducational Interpreter:-Cued Speech TransliterationEducational Interpreter:-Oral InterpretingEducational Interpreter:-Sign Language InterpretingElementary School Teacher in Grades K - 6EnglishEnglish as a Second LanguageFam & Con. Sci.Fam & Con. Sci.: Apparel, Textiles, and InteriorsFam & Con. Sci.: Child and Family DevelopmentFam & Con. Sci.: Foods/Nutrition and Food ScienceFrenchGermanGrades 5-8: Language Arts/Literacy SpecializationGrades 5-8: MathematicsGrades 5-8: ScienceGrades 5-8: Social StudiesGrades 5-8: World Language/American Sign LanguageGrades 5-8: World Language/ArabicGrades 5-8: World Language/ChineseGrades 5-8: World Language/FrenchGrades 5-8: World Language/GermanGrades 5-8: World Language/GreekGrades 5-8: World Language/HebrewGrades 5-8: World Language/ItalianGrades 5-8: World Language/JapaneseGrades 5-8: World Language/KoreanGrades 5-8: World Language/LatinGrades 5-8: World Language/Other World LanguagesGrades 5-8: World Language/PolishGrades 5-8: World Language/PortugueseGrades 5-8: World Language/RussianGrades 5-8: World Language/SpanishGreekHealth and Physical EducationHealth EducationHebrewItalianJapaneseKoreanLatinLearning Disabilities Teacher-ConsultantMathematicsMilitary ScienceMusicOther Foreign LanguagesPhysical EducationPhysical SciencePhysicsPortuguesePreschool through Grade 3PrincipalPsychologyReadingReading SpecialistRussianSchool AdministratorSchool Athletic TrainerSchool Business AdministratorSchool CounselorSchool Library Media SpecialistSchool NurseSchool Nurse/Non-InstructionalSchool Occupational TherapistSchool Physical TherapistSchool PsychologistSchool Social WorkerSocial StudiesSpanishSpeech Arts and DramaticsSpeech Language Specialist EquivalencySpeech-Language SpecialistStudent Assistance CoordinatorStudents with DisabilitiesSupervisorSwimming and Water Safety InstructorTeacher of AgricultureTeacher of Supplemental Instruction in Reading and Mathematics, Grades K-8Teacher of the HandicappedTechnology EducationTheaterOther
Select College/University*

CaldwellFDUFelicianKeanMSUNJCUNJExcelNJITPCCCRamapoRELAYRowanRutgersSeton HallStocktonTCNJWPUOther
College/University Contact Person*

First NameLast Name
College/University Contact Person Email*
example@example.com
College/University Contact Person Phone Number*

Area CodePhone Number
Upload your fingerprinting/background check information

Browse Files

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Upload your substitute teacher certificate information

Browse Files

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Please share the details of the course that requires this internship*
Upload any forms and documentation from your school relevant to this request*

Upload a File
(Memorandum of agreement, placement forms, etc.) Acceptable File Types: PDF, Microsoft Word Document (.doc, .docx) Cancelof
Click below to upload your resume*

Upload a File
Acceptable File Types: PDF, Microsoft Word Document (.doc, .docx). Cancelof
Please review our

Passaic Public Schools Internship Protocol
Signature - I have reviewed & understand the Passaic Public Schools Internship Protocol*
HR Use Only
Has this potential intern completed the fingerprinting process?
Has this potential intern completed the background check process?
- DSD Administrator Password
- Application is
  
  ApprovedRejected
- Reason for Rejection
- PPS intern placement school*
- Cooperating Team Member
- Cooperating Team Member Email
  example@example.com
- Cooperating Team Member Supervisor/Principal Email
  example@example.com
- Upload Approved Documents
  
  Browse Files
  upload documents that need to be returned to requestor Cancelof
- Should be Empty: