Fillable ELED Internship App 3.18.19 INSTRUCTIONS FOR COMPLETING STUDENT TEACHING APPLICATION

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ELED Internship App 3.18.19 INSTRUCTIONS FOR COMPLETING STUDENT TEACHING APPLICATION

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Revised 3.18.19
INSTRUCTIONS FOR COMPLETING INTERNSHIP APPLICATION
ELEMENTARY EDUCATION K-6
Applications are due in the Office of the Director Teacher Education Student Services on
October 1
st
for Spring Semester and March 1
st
for Fall Semester
Please read and follow ALL of the instructions carefully!
1. _____ Make an appointment with your advisor.
2. _____ Go to One Tech, sign in, click on student tab, and follow the menu. PRINT a copy of your Tech Transcript.
Do not go to the registrar’s office and do not go to your advisor for a copy of your ATU transcript. If you have
transfer work you will need an unofficial copy of ALL TRANSFER WORK. You will also need APPROVED copies of
your degree audit and any waivers you may have.
3. _____ Complete the personal information section of the application form.
4. _____ Complete the "Major GPA" form by filling in your grades for the classes you have completed. Calculate
quality points earned for each class. Then total the hours and points columns. Divide the total points by the
total hours; this gives you your major GPA.
5. _____ Complete the Field Experience Review Form. This form will help insure that you receive diversity in
your placement.
6. _____ Take all of the completed forms mentioned above with you to your appointment.
7. _____ Set-up an appointment with Teresa Auprey at tauprey@atu.edu in Crabaugh Room 310 to
complete your fingerprinting for your AELS background check.
IMPORTANT INFORMATION
The College of Education must have received from PRAXIS a DESIGNATED INSTUITION SCORE REPORT with a
passing Praxis II Content Knowledge Test Score for internship approval. Take the Praxis II Elementary Education:
Multiple Subjects (Math, Reading and Language Arts, Science, and Social Studies. Be sure to have your score
report sent to both ATU (code #RA6010) and the State Department of Education (code #R7031). Failure to do this
will result in an additional fee for requesting duplicate scores and will slow the processing of your application. If
you have not taken, or have not passed the Praxis II, indicate the scheduled test date on the form below.
The Arkansas Department of Education requires an APPROVED BACKGROUND CHECK before entering an
internship. This consists of fingerprinting which must be approved by both the Arkansas State Police and the FBI.
It also requires an approved Child Maltreatment form. Please contact the Office of Licensure and Support Services
in Crabaugh 310 for more information. You may also email Teresa Auprey at tauprey@atu.edu or call her at 479-
968-0623. It can take up to two months to gain this approval. Please allow sufficient time for approval so your
entry into internship won’t be delayed.
The Office of the Director Teacher Education Student Services will notify you, by OneTech e-mail, of your status
(usually after the end of the current semester) and arrange for your placement. Do not contact schools until your
placement is confirmed by this office.
Revised 3.18.19
INTERNSHIP APPLICATION
ELEMENTARY EDUCATION GRADES K-6
To Be Completed by Intern
This application must be COMPLETE to be considered for admission into Internship.
Name: __________________ _________________ _________________ Maiden: ____________________________________
(Last) (First) (Middle)
SS# _________________________________ T #_______________________ Birth Date: __________________________________
Address: __________________________________________________ OneTech e-mail Address: ______________________
City: _____________________________________________________ Home Phone: _______________________________
State: __________________________ Zip: _____________________ Cell Phone: _________________________________
CURRENT ATU TRANSCRIPT, TRANSFER TRANSCRIPT (IF APPLICABLE), APPROVED SUBSTITUTION FORMS AND DEGREE AUDIT OR
WAIVERS MUST BE ATTACHED TO THIS APPLICATION.
Have you ever been convicted of a felony? Yes_____ No______
Enter the date of your electronic fingerprinting. Date: _______________________
Candidate Signature: ___________________________________________________ Date:_______________________________
To Be Completed by your Elementary Education Advisor
Grade Point Average: Cumulative (include all transfer work): _______________ Major GPA: __________________
(Complete the attached worksheet)
When did the candidate take the PRAXIS II Content Knowledge Tests, or when does the candidate plan to take or retake the Praxis II
Content Knowledge tests? _________________________________________________________________
List any course(s) in the field of specialization or professional education with grade(s) of “D” or "F."
________________________________________________________________________________________________
List any course substitutions affecting the completion of the field of specialization or professional education.
________________________________________________________________________________________________
Has the candidate received College of Education Academic Clemency? *Yes ______ No _______
*If yes, attach a copy of the approved Academic Clemency Form.
Has the candidate completed a minimum of 12 semester hours in residence at ATU? Yes _____ No _____
Recommended By: __________________________________________ Date: _________________________
To Be Completed by Director of Teacher Education Student Services
Praxis II Score: Elementary Education Content Knowledge Scores:
Math _________ Language Arts _________ Science __________ Social Studies _________
(157) (157) (159) (155)
Approved: ________ Date: ______________
Denied: __________ Date: ______________ Reason: ____________________________________________
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Revised 3.18.19
Arkansas Tech University
Teacher Education Program
Field Experience Review for Elementary Education Internship Placement Request Form
The information provided will be used to make appropriate placements in the field. Placements are the administrative decision of
the College of Education through the Director of Teacher Education Student Services and are final.
Last Name: ___________________________________________ First Name: ________________________________________
T #__________________________________________________ Tech Email: ________________________________________
Are you currently employed by a public school? Yes _____ No _____ If yes, complete the following:
__________________________________________ ________________________________________________________
(Position) (Name of School District/City)
Do you have relatives currently employed by a public school? Yes _____ No _____ If yes, complete the following:
Name
Relationship to You
District
School/Grade level
Do you have children attending public school? Yes _____ No _____ If yes, complete the following:
Name
Relationship to You
District
School/Grade level
Revised 3.18.19
Demonstrate the diversity and variety of experience you have accumulated in the field during your preparation in teacher education.
Complete the following table: (might include observing in classrooms, tutoring, reading to a child, working in camps or with youth
groups, teaching lessons, etc.)
Course
Name of School/City
# Hrs
Grade Level(s)/Teacher
ELED 2003
ELED 3113
SPED 3023
ELED 3123
ELED 3113
SPED 3033
ELED 3143
SPED 3153
ELED 4033
(Internship I)
Describe any related work experience you have completed in the last 4 years:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
________________________________________________________________
Describe any limitations/disabilities/special considerations that may affect an appropriate placement:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Revised 3.18.19
You may not include the school at which you completed Internship I, ELED 3143, SPED 3153, any school you have been
at within the past two semesters, or the school(s) at which you have children attending or relatives employed. You
may, however, request any public-school district in Arkansas. If you are listing a specific school, please list the district
that school is a part of as well. YOUR CHOICES ARE A STATEMENT OF PREFERENCE ONLY.
1
st
Choice __________________________________
2
nd
Choice __________________________________
3
rd
Choice __________________________________
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ELED Internship App 3.18.19 INSTRUCTIONS FOR COMPLETING STUDENT TEACHING APPLICATION

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Completed 24 May 2020

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