Form

Internship Application

College of Education and Counseling
General Information
Full Name *

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

Yes No
ADA Documentation
NOTE: ADA Accomodations can only be granted for documented disabilities.

Current Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email Address *
Phone Number *

- Area Code Phone Number
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
College/Universities Attended and Degree(s) Earned
Placement Request

(Please review your information carefully before submission)
Semester (Applying For) *
Year (Applying For) *
Grade Level Request *
District Request (Not a Guarantee)
Teacher Candidate Internship Category *
Special Education Students ONLY
Primary Endorsement - (Secondary Education Students ONLY)
(Please Read)

As of September 1st, 2017, teacher candidates entering student teaching will be required to pass at least one WEST-E/NES exam prior to entering student teaching in accordance to Washington Administrative Code 181-7A-300.

By checking the box below, you certify that you have either passed or registered for at least one WEST-E/NES exam.
I have:

Passed at least One WEST-E/NES Exam Registered for at least One WEST-E/NES Exam
Test Date

- Month - Day Year
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 *
Internship Materials
Resumé *
Cover Letter *
Previous Placements Page *
Academic Prep Page *
Internship Adviser Approval Form *
Personal Affidavit, Confidentiality, and Code of Ethics
Personal Affidavit

I understand that I am not guaranteed placement in a particular school district, school building; or with a particular mentor teacher, university supervisor; and that final acceptance of a student teacher 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 placement, and in accordance to WAC 181-78A-125-b code, cannot be placed for Internship in the school or district where I graduated from. I understand I may not intern in the same building where a spouse/family member/friend is employed. Any such action on my part will result in losing the opportunity to intern teach in that school district. I will be prepared to go where Saint Martin’s University is able to secure a Teacher Internship position.

Refusal of placement for Internship may result in my application not being processed until the following semester. Furthermore, I understand if I refuse a second placement, I will forfeit Internship through Saint Martin’s University. If I request and receive a placement in a school that is not contracted with Saint Martin’s University, I understand that I may be responsible for paying the portion of fees that are above those established in accordance with Saint Martin’s University Policies.

I understand that all prerequisites and requirements must be met one month prior to the first scheduled day of Internship; otherwise my placement will be cancelled. Saint Martin’s University has my permission to release information attached to this application to school district and school personnel in order to process this request. I have read all of the pertinent sections of the Saint Martin's University Undergraduate and/or Graduate Catalog, and I have read all relevant College of Education documents. I have completed this form with information that is true and correct.

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

As an Education Student at Saint Martin’s University, I will maintain complete confidentiality regarding students, staff, and parents in the school(s) where I am placed for observation practicum and field experiences.

The public entrusts educators with a responsibility that requires exemplary service. As a Saint Martin’s University education student, I will adhere to practices that honor the dignity and worth of the students, staff, and faculty in the schools where I am placed. I will conduct myself in a manner consistent with the Code of Professional Conduct for Education Practitioners.

By signing this form, I acknowledge my fingerprints are cleared and on file in the College of Education Office.

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

Clear
Print Name *
Should be Empty:

Internship Application

General Information

Placement Request

Internship Materials

Personal Affidavit, Confidentiality, and Code of Ethics