Fillable SEED Internship App

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SEED Internship App

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The SEED Internship App form is 5 pages long and contains:

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  • 10 check-boxes
  • 133 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Arkansas Tech University

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Updated 3.18.19
INSTRUCTIONS FOR COMPLETING INTERNSHIP APPLICATION
SECONDARY EDUCATION – ALL CONTENT AREAS
Applications are due in the office of the Director of Teacher Education Student Services on
October 1
st
for Spring Semester Interns and March 1
st
for Fall Semester Interns
Please read and following ALL instructions carefully!
1. _____ Set up an appointment with your Content Area Advisor. Complete steps 2 and 3 prior to your
appointment.
2. _____ Go to OneTech, 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. _____ Fill out pages 2, 4, and 5 prior to your appointment with your Content Area Advisor.
4. _____ Take the following forms with you for your appointment with your Content Area Advisor:
a. Proposed Study Plan (Pg. 3)
b. Internship Application
c. Copies of all unofficial transcripts, substitution forms, waivers, and degree audit.
5. _____ Complete the Proposed Study Plan (Pg. 3) with your Content Area Advisor. Do not forget to get their
signature on this form.
6. _____ Make an appointment with your Education Advisor in the College of Education. Please let your advisor
know the appointment is for an internship application.
7. _____ Take entire application, including all pages, as well as the copies of your unofficial transcripts, substitution
forms, waivers, and degree audit to your meeting with your Education Advisor.
8. _____ Set up an appointment with Ms. Teresa Auprey at (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 INSTITUTION SCORE REPORT with a
passing Praxis II Content Knowledge Test Score for internship approval. 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 Ms. 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
and arrange for your placement. Do not contact schools until your placement is confirmed by this office.
Updated 3.18.19
To Be Completed by Director of Teacher Education Student Services
Praxis II Content Knowledge Name and Test Number: ___________________________________________ Score: ______________
Approved _____________________ Date ______________
Denied _______________________ Date ______________ Reason ____________________________________________
INTERNSHIP APPLICATION
SECONDARY EDUCATION
To Be Completed by the Applicant
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 ____________________________________
To Be Completed by your Secondary Education Advisor
Grade Point Average: Cumulative (include all transfer work) _______________________
When did the candidate take the PRAXIS II Content Knowledge, or when does the candidate plan to take or retake the Praxis II?
_____________________________________________________________________________________________________________
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 _________________________
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Updated 3.18.19
PROPOSED STUDY PLAN
SECONDARY EDUCATION INTERNSHIP
Candidate and Content Area Advisor - Complete Together
Last Name: __________________________ First Name: __________________________ T#:_____________________
Catalog year candidate is scheduled to graduate under: ____________________
List courses currently in progress:
____________________________
____________________________
____________________________
____________________________
____________________________
List courses needed BEFORE internship (if any) that are NOT currently in progress:
____________________________
____________________________
____________________________
____________________________
Indicate courses taken during internship:
_____ SEED 4503 (Internship Seminar)
_____ SEED 4809 (K-12 Content Areas)
_____ SEED 4909 (7-12 Content Areas)
_____ Other: ___________________
As a representative from the DEPARTMENT OF CURRICULUM AND INSTRUCTION, I recommend this candidate be
admitted to the requested stage of the ATU Teacher Education Internship Program.
Education Advisor Signature: _____________________________________________ Date: _________________
Signature of Candidate _____________________________________________________ Date: __________________
As a representative from the Department of __________________________, I recommend this candidate be admitted to
the requested stage of the ATU Teacher Education Internship Program.
Content Area Advisor Signature: _____________________________________________ Date: _________________
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Updated 3.18.19
Arkansas Tech University
Teacher Education Program
Field Experience Review for Secondary 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: ________________________________________________
Current Address: _____________________________________________________ Cell Phone _____________________________
Are you currently employed by a public school? Yes _____ No _____ If yes, complete the following:
___________________________________________ ________________________________________________________
(Position) (Name of School District/City)
Year you graduated from High School: _________________ Name of High School/District: ______________________________
Do you have relatives currently employed by a public school? Yes _____ No _____ If yes, complete the following:
Name
District
School/Grade level
Do you have children attending public school? Yes _____ No _____ If yes, complete the following:
Name
District
School/Grade level
Please check the correct content area:
Agriculture
Health and Physical Education
Art
Life Science
Business
Mathematics
Chemistry
Music Instrumental
Computer Science
Music Vocal
English
Physics
Foreign Language
Social Studies
French
German
Spanish
Speech
Updated 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)/Type of Experience
SEED 2002
SEED 4054
SEED 4556
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 any field experience hours for SEED course work 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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SEED Internship App

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Completed 24 May 2020

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