Fillable MLED Internship App 3.18.19 - MLED Internship App 3.18.19

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MLED Internship App 3.18.19 - MLED Internship App 3.18.19

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Revised 3.19.19
INSTRUCTIONS FOR COMPLETING INTERNSHIP APPLICATION
MIDDLE LEVEL EDUCATION
Applications are due in the Office of the Director of 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 OneTech, sign in, click on student tab, follow the menu, PRINT a copy of your ATU 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 an APPROVED COPY of your degree audit and any waivers you may have.
3. _____ Complete the first section of the application marked: To be completed by the applicant.
4. _____ Complete the Field Experience Preference Form. This form will help ensure that you receive
diversity in your placement.
5. _____ Take all of the above completed forms with you to your appointment.
6. _____ Set up an appointment with Teresa Auprey (tauprey@atu.edu) to complete your fingerprinting for
your AELS background check.
IMPORTANT INFORMATION
The College of Education must have received from PRAXIS a DESIGNATED INSTITUTIONAL SCORE
REPORT with passing Praxis II scores for two *Middle Level tests prior to the first day of class. Take the
Praxis II *#5047 Middle School English Language Arts, *#5169 Middle School Math, *#5089 Middle School
Social Studies, and/or *#5440 Middle School Science. Be sure to have your score reports 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.
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 479-964-0583 ext. 2351. 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 of 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 3.19.19
To Be Completed by your Middle Level Advisor
Grade Point Average: Cumulative (include all transfer work) ______________________________ Major GPA ___________________________
When did the candidate take the Praxis II Content Knowledge Test, or when does the candidate plan to take or retake the Praxis II Content
Knowledge Test? _________________________________________________________________________________________________________
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 Scores: #5047 MS E/LA ____________ #5169 MS M ____________ #5089 MS SS _____________ #5440 MS Sci _____________
Approved: ________ Date: ___________
Denied: __________ Date: ___________ Reason: ___________________________________________________________________
INTERNSHIP APPLICATION
MIDDLE LEVEL EDUCATION
Check Two Content Areas
English____ Social Studies_____ Math _____Science _____
This application must be COMPLETE to be considered for admission into Internship.
Last Name _____________________________________ First Name _______________________________ Middle Name_____________________
Maiden _____________________ SS# ___________________________ T #_________________________ Birth Date ________________________
OneTech email ________________________________________ Address ___________________________________________________________
City ____________________________ State ______ Zip ___________ Phone # ________________________ Cell #_________________________
Gender ________ Circle Ethnicity:
White, Black, Non-Resident Alien, American Indian/Alaska Native, Asian/Pacific Islander, Hispanic, Hawaiian,
Multiple Ethnicities, Other
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 _____________________________________
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Revised 3.19.19
Arkansas Tech University
Teacher Education Program
Field Experience Review for Middle Level 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
Do you have children attending public school? Yes _____ No _____ If yes, complete the following:
Name
Relationship to You
District
Revised 3.19.19
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)/Type of Experience
MLED 2003
MLED 3024
MLED 3034
MLED 3072
MLED 4023
Any Other
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:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
You may not include the school at which you completed MLED 2003 or the school(s) at which you have children attending or
relatives employed. You may, however, request any public school district in Arkansas. YOUR CHOICES ARE A STATEMENT OF
PREFERENCE ONLY.
1
st
Choice __________________________________
2
nd
Choice __________________________________
3
rd
Choice __________________________________
Comments
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
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Completed 24 May 2020

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