Currently on website 1/31/18: Clone of Form 1000 - Application for Practicum and Internship

Form 1000: Application for Practicum and Internship (SCO)

This application starts the process of your placement for practicum and internship and reserves your spot in either the Practicum (CPS 7661) or Internship (CPS 7681) course.

You will be notified by the CEHD Office of Field Placement and Certification when your placement is approved and finalized.

Cohort Year:

Expected Graduation Year

Main Campus:

Are you planning to start your practicum or Internship

PracticumInternship

Semester you plan to begin practicum or Internship:

What county are you requesting to start your practicum or internship?

If you are requesting Cobb or Gwinnett County have you completed the county application ?*

YesNo

What level are you requesting for you practicum or internship ?

ElementaryMiddleHigh

Do you have any special considerations? Ex: Marta accessibility, disability services etc

GSU E-mail*

example@student.gsu.com

Full Name

First NameLast Name

Panther ID*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Daytime Phone #*

Area CodePhone Number

Evening Phone #

Area CodePhone Number

Date Applied:

MonthDayYear

Please verify that you are human*

Student Information: