Teaching Intern Information Sheet

Education Practicum Information Form
General Information:
Name *

First Name Last Name
Check Here: *

EDU299 Education Practicum EDU398 Education Practicum EDU399 Education Field Experience

Address *

E-mail *
Phone Number *

Area Code Phone Number
Special Information:
Status: *

Sophomore Junior Senior
Desired time for practicum (EDU299 only) *

January (Before Spring Classes Begin) Spring Break May (after Spring Classes End)
School Information:
Name of school *
Accrediting agency of school *
Principal:
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail *
Secondary Interns:
A. Teaching fields:
Major
Minor/Major
B. Teacher Preferences -1
Preferences -2
(Grade level and teacher must be different from previous practicums)
Elementary and Early Childhood Interns:
A. Preferred grade level
B. Teacher Preferences -1
Preferences -2
(Grade level and teacher must be different from previous practicums)
Should be Empty:

Education Practicum Information Form