PROFESSIONAL SEMESTER III STUDENT INFORMATION FORM - FALL 2018

Students requesting a Fall 2018 PS III Internship placement, must complete this online form by 4:30 p.m. Monday March 26, 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

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. 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 March 26, 2018. (Note that any prerequisite courses for either of those internships must be successfully completed prior to the internship start.)

Select "one" of the following PS III Internships available for Fall 2018 *

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

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.

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.

Prioritize your "School Type" preference

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

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 !V.

Division Preference for Native Education Internship

Div. I & II choices are also available to students taking the 4576 Native Education Internship. If you are doing the Native Education Internship as part of your NES major, or were admitted under another major and are planning to do the 4576 Native Education Internship, indicate your division preferences below.

Indicate Your First Choice Division Preference for the Native Education Internship

Indicate Your Second Choice Division Preference for the Native Education 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

If you have applied for an Out of Zone location for your PS III internship for Fall, please indicate your division preferences below.Please note that these division preferences will only be taken into consideration for Fall internships if you are approved for an Out of Zone location PS III 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

SECTION IV: INTERNSHIP LOCATION INFORMATION

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.

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.

Rural Internships

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.

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

Alberta Education Rural Practicum Program

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 was 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. (I expect to receive the grant amount and criteria for this year by the end of March. I'm not expecting any changes from last year.) Note that you must have applied for an Out of Zone location placement by the due date of that request form (January 15), be approved and subsequently placed in a rural school in Alberta, if you are also hoping to apply for this AB Education Rural Practicum Program funding. As of yet I do not have specific information about the 2018-2019 program, however I am including this selection in the event that it might interest you. I will update students once this year's details are available.

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 school at least 150 kilometers, one way, from the U of L (my teacher preparation institution) and which may be in northern Alberta.

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'.

Out of Zone Placement

This applies to those students who submitted an Out of Zone Location request by the January 15, 2018 deadline.

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 March 26, 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 March 26, 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

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. 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 Fall 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 I must provide supporting documentation to the Field Experience Office if I have not already done so.

Marital status may be taken into consideration when making placements. If this applies to you, select the 'Married' option below, and provide a copy of your marriage certificate by the due date for supporting documentation.

Employment

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.

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.

University Sanctioned Activities

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.

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 (late August - December 21.

University Sanctioned Activity Specifics (dates/times)

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

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.

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.

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.

Leave this field blank