PROFESSIONAL SEMESTER III STUDENT INFORMATION FORM - SPRING 2014

Students requesting a Spring 2014 PS III Internship placement, must complete this online form by Friday September 27, 2013.

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
This is the address you are living at while attending the U of L.
SECTION II: INTERNSHIP PREFERENCE SELECTIONS
Internship Selection
Select "one" of the following PS III Internships available for Spring 2014
(See PS III Student Information Form Instructions for details.)
Division Preference
Prioritize your division preference
Indicate your first 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.
Div. III & IV choices are only available to students approved for the International Education or Special/Inclusive Education "Specialization" Internships.
Prioritize your school "type" preference
There may be other opportunities available for suitable PS III placement. Check the applicable box should any of the possibilities below interest you
The Assistant Dean of Field Experience will determine suitability.
For example: Public; Catholic; Christian; Hutterite; etc.) (Note: there is no guarantee you will get your preference.)
SECTION III: PLACEMENT COMPETENCY/ BEST FIT INFORMATION
Education Minor
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.
Additional Competencies
Keep in mind the division preferences you will be indicating when providing this information.

Often, schools are not able to provide you with full time instruction in your major. In such cases, we will need to place you with a teacher who instructs multiple subjects, classrooms, or in some cases with two teachers.

In an effort to make the best match available, please indicate subjects (and grade levels) that you would feel comfortable instructing.

SECTION IV: INTERNSHIP LOCATION INFORMATION
Out of Zone/International Placement
This applies to those students who submitted an Out of Zone or International Location request by the August 31, 2013 deadline.
Check the applicable box below if you have applied for an Out of Zone or International internship location
Out of Zone Location Information
If more than one, indicate your preferences in order of importance. Please note that students are not reimbursed for travel, nor are accommodations made, or monies provided for students choosing to billet for PS III internships.
If you have applied for an Out of Zone internship, indicate the address you would be living at if approved.
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.

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. (Contact Field Experience to confirm.)
Please provide the grade and school attended by your dependent child(ren) if applicable.
Health Consideration
If you have a Health issue requiring specific consideration, please indicate so above. Student's wishing consideration for a health situation are required to provide a doctor’s note detailing the requirement as it pertains to practicum placement.
Will you have a dependable vehicle available for conveying yourself (and fellow students) to practicum schools?
University Sanctioned Activities
I participate in the following University Sanctioned Activity
Please provide specific comments in the box below
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 letter of employment including the business name, supervisor and phone number to Field Experiences.)
Indicate Zone 6 schools where you have relatives working or attending (include their relationship to you). Students who have applied for Out of Zone or International PS III locations, need to provide this information for those specific areas as well.
Please indicate any other comments you think might be relevant for placement purposes.
Form Compliance Statement