PROFESSIONAL SEMESTER III STUDENT INFORMATION FORM - SPRING 2019

Students requesting a Spring 2019 PS III Internship placement, must complete this online form by 4:30 p.m. Monday September 24, 2018.

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.

Should 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 at Turcotte Hall 4th floor 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 (use 403-123-4567 format)

SECTION II: INTERNSHIP TYPE SELECTION

Select "one" of the following PS III Internships available for Spring 2019

Note that we no longer offer specific Fine Arts internships. Students admitted into the program as Art, Drama or Music majors would now select the: 4571 Elementary Education (Spring) ; the 4572 Secondary Education (Fall) ,or can choose a Specialization, or one of the other internships offered. Students admitted under the Native Education major are required to take the respective 4576 Native Education internship offered in Fall. If you wish to choose a Specialization Internship, or an Internship Option (requiring prior Student Program Service Advisor approval), you must submit the Specialization and Internship Options Application form to the Student Program Service office by September 24, 2018. (Note that any prerequisite courses for either of those internships must be successfully completed prior to the internship start.)

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

selection info

Additional Competencies

In an effort to make the best match available, please indicate the subjects (and grade levels) that you would feel most competent to instruct and include grade levels for each below.

Keep in mind the division level preferences you indicated above 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.

Prioritize your "School Type" preference

Public

Catholic

Christian

Colony

Reserve

Rural

French Immersion

DELF/DALF Level Certification

If 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.

Alternative Outreach

The Assistant Dean of Field Experience will determine suitability.

For example: Public; Catholic; Christian; Colony; etc. (Note: there is no guarantee you will get your preference.)

Division Preference

Indicate Your Zone 6 First Choice Division Preference

Make a selection here even if you have applied for an Out of Zone internship (in the event that it is not approved).

If you are not planning on doing a Specialization, other Internship Option or an Out of Zone Internship, you can proceed directly to SECTION IV.

Division Preference for Inclusive Education Internship

Indicate Your First Choice Division Preference for the Inclusive Education Internship

Indicate Your Second Choice Division Preference for the Inclusive Education Internship

Kindergarten, Div. I & II are the grade level choices available to students taking the 4582 Inclusive Education Internship. Please note that Inclusive Education Internships will be made in schools within a commutable distance of Lethbridge. Out of Zone locations will not be considered for this Specialization internship.

Division Preference for Early Childhood Education Internship

Indicate Your First Choice Division Preference for the Early Childhood Education Internship

Division Preference for an Out of Zone location Internship

Indicate Your First Choice Division Preference for the Out of Zone Location

Indicate Your Second Choice Division Preference for the Out of Zone Location

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

Please note that division 3 and 4 preferences will only be taken into consideration for Spring internships if you are approved for an Out of Zone location PS III internship.

SECTION IV: INTERNSHIP LOCATION INFORMATION

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

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

PS III interns are not reimbursed for travel, nor are they billeted. Therefore, we endeavour to place interns within a daily commutable distance of the address you provided in Section I of this form or where you indicate that you have free accommodation below .

Rural Internships

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.

Rural Locations of Interest

Many rural schools would love to have PS III interns, however due to their distance, do not often get to experience the opportunity. If you are interested in a rural placement, please select the appropriate choice below.

Alberta Education Rural Practicum Program

Interest in Alberta Education Rural Practicum Placement

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 Alberta school at least 150 kilometers, one way, from the U of L (my teacher preparation institution) .

AB Education Rural Program locations that Interest me

Keep in mind that you would need to have submitted an Out of Zone request in order to select a rural distant location 'outside of Zone 6'.

Alberta Education is once again 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 that the placement should be in a school at least 150 kilometers, one way, from your teacher preparation institution, and may be in Northern Alberta. Note that if you are interested in a rural placement outside of Zone 6, and are also hoping to apply for this AB Education Rural Practicum Program funding.you must have applied for an Out of Zone location placement by the due date of that request form (August 31), be approved by the Assistant Dean of Field Experience and subsequently placed in a rural school in Alberta. Interns placed in rural Alberta schools that meet the funding criteria will be sent an application form by the Field Experience Program Specialist.

Out of Zone Placement

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

I applied for an Out of Zone location placement by the due date.

Provide any updates/changes regarding Out of Zone location requests to Diane McKenzie via email by September 24, 2018

My information remains as submitted on my request.

I have or intend to provide an update/change to my original Out of Zone request and understand that I must do so by the September 24, 2018 due date of this form.

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.

Out of Zone Placement City (if applicable)

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

Please use the 403-123-4567 format

This applies to those students who submitted an Out of Zone Location request by the August 31, 2018 deadline.

SECTION V: ADDITIONAL INFORMATION

additional info

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. Note that situations will be prioritized as will timeliness of receipt of supporting documentation.

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.

Transportation

Will you have access to a vehicle for the purpose of transport to the school you are placed at for PS III?

Yes

Vehicle Comments

Family

I have a dependent child(ren)

Yes

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

Dependent Child Grade and School Information

Please provide the grade and school attended by your dependent child(ren) if applicable.

Marital Status

Yes, I am married and understand that I must provide supporting documentation (marriage certificate) to the Field Experience Office (if I have not already done so) in order to have this taken into consideration.

Employment

I am employed and will continue to be during my PS III Internship

Yes

Indicate the name of the business, and the position you are employed in below

This information does not replace the actual letter from your employer.

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.

University Sanctioned Activities

I participate in University Sanctioned Activities

If you selected an activity above, note it's specifics below .

In addition to providing specifics below, students must provide supporting documentation from their U of L coach or director etc., which includes the dates/times of season/event for consideration by the due date indicated at the top of this form. Schedules/specifics will need to be reflective of the Professional Semester III Internship (January - April).

University Sanctioned Activity Specifics (dates/times)

Current participation in "university sanctioned" extra-curricular activities may be taken into consideration for placement purposes. This section does not refer to intramural or non-university activities. Please see Appendix K 'Attendance Policy' of the Student Handbook.

Health Consideration

If you have a Health issue requiring specific consideration, (affecting placement location), select the button below. You will need to provide a signed doctor’s note on letterhead detailing the requirement (expected duration) with regard to practicum placement, and also indicating that this health situation (within reason) would not negatively affect your participation in the internship.

Yes, , I have a health situation that I would like taken into consideration and understand that I must provide supporting documentation from my doctor outlining how it will affect my internship.

School Confilict Information

Indicate the relationship of your relative(s) below, as well as the name of the school and city/town it is in

This would include information for: immediate relatives (mother, father, brother, sister, grandparents); if applicable, your spouses immediate relatives; your aunts,uncles and first cousins.

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

General Comments/Information

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

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.

PROFESSIONAL SEMESTER III STUDENT INFORMATION FORM - SPRING 2019

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