Zone 5 Ed 2500 PSI, II, III Student Teacher/Intern Request 2024/2025

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.

Section 1: General Teacher Information

Salutation:

Given: *

Surname: *

Pronouns:

Please indicate your pronouns if you wish to share them with your student teacher. This information is confidential, and will only be provided to the student teacher in their placement information.

E-mail: *

School Name: *

School City: *

Permanent Certificate: *

Yes

Years of teaching experience: *

Fall Grade(s)/Subjects (Sep. - Dec.): *

Spring Grade(s)/Subjects (Jan. - Jun.): *

What is/will your 2024-2025 teaching assignment be?: *

Full-Time

1/2-Time

Have you mentored a U of L Student Teacher/Intern before?: *

Yes

Section 2: Placement Information

Please indicate the level(s) of practicum student you are interested in. If you have more than one preference, specify preference by number order (i.e. 1,2,3). We cannot guarantee preferences or placements, however we will do our best to accommodate your request. Requests will be kept on file for the 2024/2025 school year:

	1	2	3	4	5
Education 2500: Grades K - 6, Summer (May-Jun)	Education 2500: Grades K - 6, Summer (May-Jun) - 1	Education 2500: Grades K - 6, Summer (May-Jun) - 2	Education 2500: Grades K - 6, Summer (May-Jun) - 3	Education 2500: Grades K - 6, Summer (May-Jun) - 4	Education 2500: Grades K - 6, Summer (May-Jun) - 5
Professional Semester I (PS I): usually Grades 1 – 6, five-week practicum offered in Fall once yearly (November to December)	Professional Semester I (PS I): usually Grades 1 – 6, five-week practicum offered in Fall once yearly (November to December) - 1	Professional Semester I (PS I): usually Grades 1 – 6, five-week practicum offered in Fall once yearly (November to December) - 2	Professional Semester I (PS I): usually Grades 1 – 6, five-week practicum offered in Fall once yearly (November to December) - 3	Professional Semester I (PS I): usually Grades 1 – 6, five-week practicum offered in Fall once yearly (November to December) - 4	Professional Semester I (PS I): usually Grades 1 – 6, five-week practicum offered in Fall once yearly (November to December) - 5
Professional Semester II (PS II): usually Grades 7 – 12, but also Elementary grades, six-week practicum offered once yearly in Spring (March to April)	Professional Semester II (PS II): usually Grades 7 – 12, but also Elementary grades, six-week practicum offered once yearly in Spring (March to April) - 1	Professional Semester II (PS II): usually Grades 7 – 12, but also Elementary grades, six-week practicum offered once yearly in Spring (March to April) - 2	Professional Semester II (PS II): usually Grades 7 – 12, but also Elementary grades, six-week practicum offered once yearly in Spring (March to April) - 3	Professional Semester II (PS II): usually Grades 7 – 12, but also Elementary grades, six-week practicum offered once yearly in Spring (March to April) - 4	Professional Semester II (PS II): usually Grades 7 – 12, but also Elementary grades, six-week practicum offered once yearly in Spring (March to April) - 5
Professional Semester III (Fall Internship): All grades offered, four-month internship (late August to December)	Professional Semester III (Fall Internship): All grades offered, four-month internship (late August to December) - 1	Professional Semester III (Fall Internship): All grades offered, four-month internship (late August to December) - 2	Professional Semester III (Fall Internship): All grades offered, four-month internship (late August to December) - 3	Professional Semester III (Fall Internship): All grades offered, four-month internship (late August to December) - 4	Professional Semester III (Fall Internship): All grades offered, four-month internship (late August to December) - 5
Professional Semester III (Spring Internship): All grades offered, four-month internship (January to April)	Professional Semester III (Spring Internship): All grades offered, four-month internship (January to April) - 1	Professional Semester III (Spring Internship): All grades offered, four-month internship (January to April) - 2	Professional Semester III (Spring Internship): All grades offered, four-month internship (January to April) - 3	Professional Semester III (Spring Internship): All grades offered, four-month internship (January to April) - 4	Professional Semester III (Spring Internship): All grades offered, four-month internship (January to April) - 5

Agree *

I have made my school administrator aware of my interest in mentoring a U of L student teacher for the 2024/2025 school year, and understand that my school administrator will be contacted to discuss specific placements in a school prior to each respective practicum semester.

Submitted requests do not guarantee that a student will be placed with a teacher, but rather are an indication of interest and support. The information you provide will facilitate the assignment of practicum students in the coming school year.

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Zone 5 Ed 2500 PSI, II, III Student Teacher/Intern Request 2024/2025

2024/2025 Faculty of Education - Field Experiences

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