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

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 III: PLACEMENT COMPETENCY/BEST FIT INFORMATION
If you have a completed teachable Minor, please check the respective box below. This information may be used to identify a suitable internship placement for you.
Education Minor
Additional Competencies
Keep in mind the Division Level Preferences you intend to indicate below when providing this information.

Often, schools are not able to provide you with full time instruction in your teachable major, (most especially in the case of non-core subject majors). In such instances, we will need to place you with a teacher who instructs multiple subjects or levels, or in some cases with two teachers.

Division Level Preference
Prioritize your 4571: Elementary Education division preference
Indicate your first preference.
Prioritize your "School Type" preference.
Catholic
Public
Other
Examples of "Other" selections are: Christian; Hutterite; Reserve; Rural; or Multi-Grade.
(Note: there is no guarantee you will get your preference.)
Specialization or Special Focus Internships
First Choice Division for Specialization, Special Focus , Out of Zone or International Internship

Select your first choice.

Second Choice Division for Specialization, Special Focus, Out of Zone or International Internship
Select your second choice.
Impact of Late Starting Secondary Level Specialization or Special Focus Internships
Students selecting a Specialization or Special Focus internship and who are also selecting and are subsequently placed at the division III or IV level 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.
If you have applied for either the 4573 International Education internship, or the 4573 Special/Inclusive Education "Specialization" Internship this Spring (and expect to successfully complete the prerequisite course(s) prior to your internship start), please indicate your division preferences below. Please note that if you do not successfully complete the prerequisite course(s) for your Specialization or Special Focus Internship request, a 4571 Elementary Education internship will be identified for you.
Division Preference for Out of Zone/International Internship
Indicate Your First Choice Division Preference for Out of Zone /International Location
Indicate Your Second Choice Division Preference for Out of Zone/International Location
Impact of Late Starting Out of Zone/International Internships
Students selecting an Out of Zone or International internship who are also selecting and are subsequently placed at the division III or IV level 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.

If you have applied for an Out of Zone or International location PS III internship for Spring, please indicate your division preferences below.

Please note that these division preferences will only be taken into consideration for Spring internships if you are approved for an Out of Zone or International location PS III internship. Should you not be approved for an Out of Zone or International location, a 4571 Elementary Education internship will be identified for you.

SECTION IV: INTERNSHIP LOCATION INFORMATION
If you are indicating more than one selection, place your them in order of importance.
Rural Internships
Rural Internship Opportunities

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.

Out of Zone/International Placement
Check the applicable box below if you have applied for an Out of Zone or International internship location
Provide any updates/changes regarding Out of Zone or International location requests to Diane McKenzie via email by September 26, 2016
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.
Please use this sample format 234-567-8901.
This applies to those students who submitted an Out of Zone or International Location request by the August 31, 2016 deadline.

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.

SECTION V: ADDITIONAL INFORMATION

The information in this section is used to assist us in accommodating students who have dependent children and those who have other situations that might be negatively impacted by practicum placement location.

Should you wish to have your situation taken into consideration for your PS III internship, you will need to provide the respective information and proof to substantiate it.

If you have provided any of the documentation in the past "and it remains relevant", you do not need to re-submit it for PS III consideration. Students are encouraged to confirm that any relevant information is on file and to ensure that current information, "pertinent to the coming Spring semester" is submitted.

Family
I have a dependent family member(s)

If you select the box above indicating that you have a dependent family member, you will need to provide a copy of their Alberta Health Care card or Birth Certificate,(if you have not done so already).

Please provide the grade and school attended by your dependent child(ren) if applicable.
Health Consideration
If you have a health situation requiring specific consideration, please indicate so below and provide Field Experience with a doctor’s note detailing the requirement as it pertains to practicum placement
Transportation Information
Will you have access to a vehicle for the purpose of transport to the school you are placed at for PS III?
University Sanctioned Activities
I participate in University Sanctioned Activities
Schedules/specifics will need to be reflective of this PS III internship semester.
Current participation in "university sanctioned" extra-curricular activities may be taken into consideration for placement purposes. (Students must provide supporting documentation including dates of season/event for consideration.)
Employment
I am employed and will continue to be during my PS III Internship
Employment may be taken into consideration for placement purposes. Students must provide a signed letter from their employer that includes: the business name; supervisor name and phone number; and planned work schedule (i.e. Mon. & Fri. 5:00 - 9:00pm)to Field Experiences.
School Confilict Information
This would include information for immediate relatives (mother, father, brother, sister, grandparents); your aunts,uncles and first cousins; as well if applicable, your spouse's immediate relatives.

We endeavour not to place students in schools where they have relatives working or attending. This applies to students placed in Zone 6, Out of Zone and in International schools.

Please indicate any other comments above that you think might be relevant for placement purposes.
Form Compliance Statement