Practicum Application

Practicum Application

College of Education and Counseling
General Information
Full Name *

First Name Middle Name Last Name
Student ID Number *
Campus *
Term (JBLM Students Only)
Faculty Advisor *
ADA Accommodations *

Yes No
ADA Documentation
NOTE: ADA Accomodations can only be granted for verified disabilities.
Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email Address *
Phone Number *

Area Code Phone Number
Note: If you are currently enrolled as an Educational Studies student, you should NOT be registering or taking any of the practicum courses. Please speak with your adviser for further information and details.

(Educational Studies is a non-certification program for students who are interested in gaining knowledge, skills and pedagogy in education theory and application. It involves NO teaching practicum experience)
Are you an Educational Studies student? *

Yes No
Endorsements *

Other: Educational Studies Bilingual Education Biology Chemistry Drama Early Childhood Education Early Childhood Special Education Elementary Education English Language Arts English Language Learners French Health/Fitness History Japanese Mathematics Middle Level Humanities Middle Level Mathematics Middle Level Science Music: Choral Music: Instrumental Music: General Reading/Literacy Social Studies Spanish Special Education
Placement Requests
Note: In practicum experience, you can NOT request for a particular teacher or school building. However, you can suggest or recommend a school district or grade level that you are interested, but they are NOT always guaranteed.
Semester *
Year *
School District Request (NOT GUARANTEED) *
(Please only enter school districts'names, do not enter a particularly teacher/building)
Grade Level (NOT GUARANTEED)
When can you start your practicum? *
Level 1 Practicum (30 Hour)

ED 304/MED 504 Directed Practicum Level 1 Foundation
Level 2 Practicum (30 Hour)

ED 408/MED 508 Elementary Practicum Level 2 ED 408/MED 508 Secondary Practicum Level 2
90 Hour Practicum (90 Hour)

ED 492/MED 592 Elementary ED 479/MED 579 Reading ED 423/MED 523 English Language Learners (ELL) ED 487/MED 587 Secondary SED 469/MED 569 Special Education
Specialty Practicum (10 Hour)

SED 359/MED 559 Introduction to Exceptionality (10 Hours)
Others

ED 491 Added Endorsement Practicum ED 497 Directed Practicum
Educational Studies Practicum

Alternative Placement for Educational Studies Students Only (Hands On Children's Museum, YMCA, WET Science Center, Learning Academy. etc.)
It is a Saint Martin's CEC policy that education candidates may not conduct practicum or internship hours in a school in which they have a family member. Please list any family members, their relationship to you, the school they attend/work at, and their role.

Example:

Jane Doe - Aunt - Capitol High School - English Teacher

John Doe - Cousin - Lakes Elementary - 2nd Grade Student
Family *
Personal Affidavit, Confidentiality, and Code of Ethics
Personal Affidavit

I understand that I am not guaranteed a particular placement in a school district or school building, with a particular mentor teacher or university supervisor, or during a particular semester. Final acceptance of a practicum is the prerogative of the school district.

I understand that I am not to make arrangements with any school district or school personnel regarding my practicum placement. I will be prepared to go where Saint Martin’s University is able to secure a practicum position.

I understand my fingerprints must be completed and valid and the receipt must be turned into the Education Office.

I understand I may not request or accept a placement in a school where my spouse, a friend or a relative is employed, or where any of my children attend.

Please sign below by clicking and holding your mouse or touchpad.
Personal Afidavit Signature *

Clear
Print Name *
Candidate Oath of Confidentiality and Code of Ethics

The public entrusts educators with a responsibility that requires examplary service. As an Education Candidate at Saint Martin's University, I will maintain complete confidentirlairy about students, staff, and parents in the school(s) where I am placed for observation, practicum, and/or field experience.

I will adhere to practives that honor the dignity and worth of the students, staff, and faculty in the school(s) where I am placed and I will conduct myself in a manner consistent with the Professional Certification Code.

By signing this form, I acknowledge my fingerprints are cleared and on file in the Collge of Education and Counseling Psychology office.

I understand I may not request or accept a placement in a school where my spouse, a friend, or a relative is employed, or where my children attend.

Please sign below by clicking and holding your mouse or touchpad.
Code of Confidentiality and Code of Ethics Signature *

Clear
Print Name *
Should be Empty:

Practicum Application

General Information

Placement Requests

Personal Affidavit, Confidentiality, and Code of Ethics