Education 2500 Student Information Form - Spring 2024 Foip Statement Protection of Privacy - The personal information requested on this form is collected under the authority of Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act (“Act”) and will be protected under Part 2 of the Act. The information is collected for the purpose of identifying practicum and internship placements for students. If you have any inquiries in regards to the collection of your personal information, please direct those inquiries to: FOIP Coordinator, University of Lethbridge, 4401 University Dr. West, Lethbridge, Alberta T1K 3M4, telephone: 403-332-4620, email: foip@uleth.ca. Demographics Student Given Name: * Student Surname: * Street Address and City: * (While attending the U of L) Telephone: * U of L Email: * Emergency Contact: * Emergency Contact Phone Number: * Ed 2500 Seminar Section: * School Information Any special circumstances influencing location of your placement? * - Select -YesNo What are they? Do you have a car? * - Select -YesNo Do you have relatives attending/working in any Lethbridge schools? * - Select -YesNo Please indicate the schools below: Do you have an on-campus course directly after practicum? * - Select -YesNo What time? Preferred School Type (1 is most preferred): 1234 Public Public - 1 Public - 2 Public - 3 Public - 4 Catholic Catholic - 1 Catholic - 2 Catholic - 3 Catholic - 4 Christian Christian - 1 Christian - 2 Christian - 3 Christian - 4 French Immersion French Immersion - 1 French Immersion - 2 French Immersion - 3 French Immersion - 4 DELF/DALF Competency Level (For French Immersion Placements Only): 0| DELF A1 1| DELF A2 2| DELF B1 3| DELF B2 4| DALF C1 5| DALF C2If you selected French Immersion above, please indicate your DELF/DALF certification level to assist us in determining placement suitability, and provide a copy of your certificate to the Field Experience office. Have you previously completed or withdrawn from Ed 2500? * Yes No Leave this field blank Submit