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.
Are you an Educational Studies student? *

Yes No
Endorsements *

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
Semester
Year
Note: In practicum experience, you may not request for a particular teacher or school. However, you can suggest and recommend a school district that you are interested, but it is not guaranteed.
School District Request (NOT GUARANTEED)
When can you start your practicum?
Practicum Level 1

Select that you need a 30 hour, Practicum Level 1 placement if you are taking ED 304/MED 504.

Practicum Level 2

Practicum Level 2 is broken in to three subsets:

ED 408A/MED 508A taken by elementary students who are taking methods classes related to STEM, such as, ED 411, 415, or 418.

ED 408B/MED 508B is taken by elementary students who are taking methods classes related to the Humanities, such as, ED 495A, 495B, 426, 429, or 438.

ED 408C/MED 508C is taken by secondary students who are taking ED 495D - Secondary Literacy.
Level 1 Practicum

ED 304/MED 504 Directed Practicum Level 1 Foundation
Level 2 Practicum

ED 408 A/MED 508A Elementary STEM ED 408 B/MED 508B Elementary Humanities ED 408 C/MED508C Secondary
90 Hour Practicum

ED 492/MED 592 Elementary ED 479/MED 579 Reading ED 423/MED 523 ELL ED 487/MED 587 Secondary SED 469/MED 569 Special Education
Specialty Practicum

SED 359/MED 559 Introduction to Exceptionality (10 Hours)
It is a Saint Martin's CECP 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