APPLICATION FOR INTERNSHIP
Alabama A & M University
Office of Field Experiences and School Partnerships
Directions for completing application:
Applications are submitted one year before the intended internship. March 15 (of the previous year) is the application deadline for an internship during a Spring Semester. September 15 (of the previous year) is the application deadline for an internship during a Fall Semester.
Type the application. Submit two copies to the Office of Field Experiences and School Partnerships (room 215 Carver Complex North – temporary location during renovations).
Semester Applying for Internship: Expected Date of Graduation:
(Semester) (Year) (Semester) (Year)
Graduate Undergraduate Program Major
Please answer each question completely and accurately.
Personal Data:
Candidate:
Title (e.g., Mr., Mrs., Ms.) Last First Middle Maiden Suffix (e.g., Jr., Sr.)
Student I.D. No.: Date of Birth: Place of Birth:
(month/day/year) (city/state)
Marital Status: Number of Children: Age(s):
Local Address:
Street/Apt/P.O. Box/Route and Box City State Zip Code
Permanent Address:
Street/Apt/P.O. Box/Route and Box City State Zip Code
Email address: Local Telephone Number: ( )
Permanent Telephone No.: () Mobile Telephone Number: ()
Name of Emergency Contact Person:
Telephone Number of Emergency Contact Person: ()
TB Test/Health Form on file in the Teacher Service Center (valid for 24 months only): Yes No
Please list any health problems that may interfere with your internship (i.e., asthma, diabetes, migraine headaches, etc.)
Language Spoken at Home: Other Language(s) Spoken:
Personal Data: (Continuation)
High School Attended:
City/State:
Other College(s)/University(ies) Attended:
Academic Data:
Classification: (check one) Undergraduate (Senior) Graduate (5th Year)
Major:
Academic Advisor: Departmental Chairperson:
Date of State Approved Checklist Used:
(month/day/year)
Approved Departmental Course Substitution on file with the Academic Coordinator in the School of Education, if applicable: (check one) Yes No Does not apply
Overall GPA: General Studies GPA:
Professional Studies GPA: Teaching Field(s) GPA:
Have completed required minimum 205 clock hours of field experiences and have submitted documentation to The Office of Field Experiences and School Partnerships: (check one) Yes No
Have taken and passed the Praxis II exam: (check one) Yes No
Date Taken: Score: Subject Area:
Have been fingerprinted and passed the SDE background check: (check one) Yes No and
a copy is on file with the Teacher Service Center: (check one) Yes No
Professional Educational Membership(s):
Internship School Placement Requests:
Directions: You may only request the schools that are in the Alabama A & M University Cluster for the year of the intended internship (see the School Cluster Sheet that changes from year to year):
Suggested School(s):
lst
Name of School District
2nd
Name of School District
3rd
Name of School District
Area(s) of intended certification (e.g., elementary K-6, PE P-12, Music Vocal P-12, ECH K-3, Col K-6, Col 6-12, Art P-12, Ag 6-12, FCS 6-12, Business ED 6-12, Secondary 6-12):
lst
2nd
Requested Subject(s):
lst
2nd
3rd
Requested Grade Level(s):
lst
2nd
3rd
List course(s) currently enrolled. If none, please indicate “NONE”
COURSE NUMBER AND TITLE / SEM. HRS.List course(s) in which you plan to enroll during the semester BEFORE the internship. If none, please indicate “NONE”
COURSE NUMBER AND TITLE / SEM. HRS.List any deficiencies including D’s, F’s, I’s. If none, please indicate “NONE.” (Do not include course(s) currently enrolled)
COURSE NUMBER AND TITLE / GRADE(List D’s, F’s, I’s) / SEM. HRS.
Candidate’s Signature: Date:
Name of Candidate: Student I.D. No.:
Self Assessment: (completed by candidate)
HAVE MET THE FOLLOWING REQUIREMENTS(Check Met or Not Met) / Undergraduate
Requirement / Graduate
Requirement / Met / Not
Met
1. Have record audit checklist from academic advisor / x / x
2. Have submitted Senior Record Check Form to Academic Coordinator / x
3. Have been admitted to a teacher education program / x / x
4. Application for admission to Teacher Education on file in TSC / x / x
5. Passing score on APTT / x / x
6. Have taken the GRE (Graduate Record Examination) / x
7. Passing score on verbal portion of GRE (400 or better) or ENG 500 (Writing for Graduates) on file in TSC / x
8. Passing score on quantitative portion of GRE (400 or better) on file in TSC, if not must take MTH 500 and earn “C” or better / x
9. Passing score on Speech-Hearing-Language Screening / x / x
10. Passing score on Faculty Panel Interview / x / x
11. Health Record Form on file in TSC (valid for 24 months only) / x / x
12. Grade Point Average of 2.50 in four areas: (Overall, General Studies, Professional Studies and Teaching Field) / x
13. Grade Point Average of 3.00 in three areas: (Overall, Professional Studies and Teaching Field) / x
14. Official undergraduate transcript from each college/university attended on file in Teacher Service Center / x
15. Planned Degree on file in Teacher Service Center / x
16. Approved Course Substitution on file with Academic Coordinator in the School of Education, if applicable / x
17. Grade of “C” or better in ENG 101, ENG 102, Professional Studies and Teaching Field Courses / x
18. Have earned less than two C’s in graduate program. / x
19. Have removed I’s, D’s, F’s, if not please list course(s) below: / x / x
20. Have taken all General Studies courses, if not please list course(s) below: / x
21. Have taken all Professional Studies courses, if not please list course(s) below: / x / x
22. Have completed all undergraduate deficiencies / x
23. Have taken Praxis II and passed prior to internship (Effective Fall 2006) / x / x
24. Have passed background clearance before engaging in internship. / x / x
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