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

2024/2025 Faculty of Education - Field Experiences

(For use by Zone 5 in CBE, CSSD, Foothills and Rocky View teachers interested in U of L
Professional Semester I, II, and III Student Teachers and Interns)

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
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.
Permanent Certificate:
What is/will your 2024-2025 teaching assignment be?:
Have you mentored a U of L Student Teacher/Intern before?:
Section 2: Placement Information
Questions 1 2 3 4 5
Agree
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.