PROFESSIONAL SEMESTER III STUDENT INFORMATION FORM - SPRING 2017

Students requesting a Spring 2017 PS III Internship placement, must complete this online form by Monday September 26, 2016.

Students who do not provide all relevant information, or who provide false information, may be required to withdraw from the practicum and reapply for admission to resume their studies in a subsequent year.

Shoud you have any questions, feel free to contact Diane McKenzie via email at diane.mckenzie@uleth.ca ; via phone 403-329-2448; or in person on the 4th floor of Turcotte Hall, room 427.

SECTION I: CONTACT INFORMATION

U of L ID Number *

Last Name *

First Name *

U of L E-mail Address *

Current Home Address *

This is the address you are living at while attending the U of L.

City *

Province *

Postal Code *

Phone Number *

This is the phone number you would prefer we use to make contact with you.

SECTION II: INTERNSHIP TYPE SELECTION

Select "one" of the following PS III Internships available for Spring 2017 *

4571: Elementary Education

4573: International Education (Special Focus)

4573: Special/Inclusive Education (Specialization)

4573: Technology in Education "Elementary" (Specialization)

4572: Secondary Education

Note: The 4572 Secondary Education internship is only applicable to students approved for an Out of Zone or International location placement. Spring PS III students placed in a school whose semester starts late January or early February may not be finished their internship by the end of the Spring semester. As a result, they may not be eligible for Spring graduation if it is their final semester. Those students would also be unable to take Summer Session I courses. (See PS III Student Information Form Instructions for details on internship types.)

SECTION IV: INTERNSHIP LOCATION INFORMATION

PS III interns are not reimbursed for travel, nor are they billeted, as is the case for PS I and II distant placements. Therefore, we endeavour to place interns within a daily commutable distance of the address they provide in Section I of this form.

I am hoping to complete PS III in the Zone 6 city/town of

If you are indicating more than one selection, place your them in order of importance.

Rural Internships

There are rural internship placement opportunities available. Alberta Education is providing an opportunity for students placed in 'distant' rural locations to apply for stipends (usually in the amount of $2,000 each). The criteria for applications is: the placement should be in a school at least 150 kilometers, one way, from your teacher preparation institution; and may be in northern Alberta.

Rural Internship Opportunities

I am interested in an un-funded, 'commutable' (under 90kms one way), rural placement opportunity.

I am interested in a Zone 6 'distant' rural placement opportunity, whether or not funding may be available to me.

I am interested in an AB Rural Practicum Program placement opportunity and understand that in order to be eligible for that funding, I would need to be placed in a rural school at least 150 kilometers, one way, from the U of L (my teacher preparation institution) and which may be in northern Alberta, (if I have applied for an Out of Zone placement by the required August 31 due date).

Rural Locations of Interest

Out of Zone/International Placement

This applies to those students who submitted an Out of Zone or International Location request by the August 31, 2016 deadline.

Check the applicable box below if you have applied for an Out of Zone or International internship location

Out of Zone

International

Provide any updates/changes regarding Out of Zone or International location requests to Diane McKenzie via email by September 26, 2016

My information remains as submitted on my request.

I have or intend to provide an update/change to my original Out of Zone or International request.

Out of Zone Placement Address (if applicable)

If you have applied for an Out of Zone internship, indicate the address you would be living at if approved. This will aid in identifying suitable schools/locations.

Out of Zone Placement City (if applicable)

Out of Zone Placement Phone Number (if different from that provided in Section I)

Please use this sample format 234-567-8901.

Form Compliance Statement *

By selecting this, I am confirming that I have read and understood this PS III Student Information form and certify that all of the information that I have provided is complete and accurate. Where I have indicated a request for consideration on this form, I understand that if I have not attached or provided the required documentation, consideration will not be made.

Leave this field blank