Teaching Intern Information Sheet

Education Practicum Information Form
General Information:
Name *

First Name Last Name
Choose One: *

EDU299 Education Practicum EDU398 Education Practicum EDU399 Education Field Experience
Choose Time Frame *

Pre-semester (January) Spring Break Post-semester (May) (With Special Permission)
Practicum School Information:
Name of School *
Location of School *
Accrediting Agency of School
Principal Information:
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail *
Secondary Education Majors:
1st Teaching Field *
2nd Teaching Field *
Preferred Grade Level *

Middle School High School No Preference
Teacher Preference: (1st Teaching Field)
Teacher Preference: (2nd Teaching Field)
(Grade level and teacher must be different from previous practicums)
Elementary Education Majors:
Preferred Grade Level

1-2 3-4 5-6 No preference
Teacher Preference: (First Choice)
Teacher Preference: (Second Choice)
Should be Empty:

Education Practicum Information Form