EDEC 3929/4570 Practicum or Preprimary Professional Internship INFORMATION FORM—

Ohio University-Lancaster

PRE-PRIMARY 2012-2014

___ Summer 2012 _____Fall 2012 _____Spring 2013 ____Fall 2013 __Spring2014

Quarter /Semester & Year for PrePrimary Student Teaching______;

Semester & Year for Primary Student Teaching: ___

NAME: ______PID#:______Date of Application: ______

E-MAIL Address:

Local Address and Phone:

Permanent Address and Phone if different from local:

Indicate Supervised Field Experiences and Teaching with Children (List pre-k field experience with the program, the classroom teacher’s name, and indicate diversity: special needs, low income, or racial diversity):

Program Teacher Public/Private

EDEC260L/3700: ______

EDECF361L/3610: ______

EDEC363L/3801: ______

EDEC364/2300 (Child Development student only): ______

EDEC365L (Child Develop student only): ______

Indicate Other Experiences with Young Children:

Describe Special Talents, Hobbies and Interests:

Indicate your preferred cooperating teacher if you know one and his/her program address and contact number (for possible consideration only, the instructor decides where each student is placed depending on the diversity of your past field experiences and availability of the site.):

Preference of AM or PM: (for possible consideration only)

Notes to the application:

·  * Pre-Primary Professional Internship will most likely be in the Fall and Winter Quarter, occasionally it may be scheduled in Spring or Summer depending on the number of qualified placements and the availability of the instructor.

·  ** Spring will be for Child Development Associate Degree Majors in most years (EDEC366). Sometimes, ECE students may also take EDEC400/474 in spring

·  The instructor reserves the right to limit the number of professional interns per session. You may be asked to switch with Primary professional internship quarter if the number of applicants in a particular quarter exceeds the limit.

·  Please also note that pre-primary professional internship is a half day everyday 11 week-long experience. You should only take one more course in addition to your student teaching and seminar.

·  It is extremely important that you notify me if you have changes in your plan for your internship schedule so that you will still have a spot for the desired quarter.

·  You must attached a copy of your most recent DARS. Incomplete applications will result in being placed on the waiting list when applicable.

Please sign your name to indicate that you have read the application and the notes.______

(Applicant Signature)

Return to: Dr. Qiuping Cao, Ohio University-Lancaster, Lancaster, OH 43130

Revised Dec. 19, 2011.