College of Education and Human Development Office of Field Experiences

NON-MASTER’S ALTERNATE CERTIFICATION
APPLICATION FOR STUDENT TEACHING/INTERNSHIP
Fall 2010

Application deadline is January 31, 2010.

Application for student teaching/internship must be made with the Office of Field Experiences one semester prior to the student teaching semester. Students expecting to student teach in the Fall semester must apply on or before January 31 of that year.

Non-Master’s Alternate Certification students applying to student teach/intern in Fall 2010 must enroll in Internship III in Spring 2010 and must complete all coursework by August 2010.

Biographical Information

First Name:      Last Name:

UNO E-mail address:      Date Of Birth:

Gender: Select Male Female       Ethnic Background: select............. White Black Hispanic Asian/Pacific Islander American Indian/Alaskan Native Prefer not to provide   

Local Address

Street:

City: State: Zip:

Parish: select....... Jefferson (East Bank) Jefferson (West Bank) Orleans (East Bank) Orleans (West Bank) St. Bernard St. Charles St. Tammany Other       

Contact Information

Home Phone: Cell Phone:

Work Phone:

Emergency contact:

Relationship: Phone:

Student Information

UNO Student Number:

Social Security Number:

High School: Year Graduated:      

TEACHER CERTIFICATION AREA

Early Childhood Certification:            Select........ Early Childhood (PK-3)

Elementary Certification:                    Select............ Elementary (1-5)         

Middle School Certification:              Select....... English (4-8) Math (4-8) Science (4-8) Social Studies (4-8)

Secondary Certification:                    Select...... Biology (6-12) Chemistry (6-12) Earth Science (6-12) English (6-12) Mathematics (6-12) Social Studies (6-12) General Science (6-12) Physics (6-12)

School District Choices: Select..... Jefferson(East Bank) Jefferson(West Bank) Orleans(East Bank) Orleans(West Bank) Plaquemines St. Bernard St. Charles St. Tammany          

Grade Level Choices:    1st Choice:   2nd Choice:

Are you applying for student teaching or internship? Select... student teaching internship

If internship, please complete:
School District:           School Name:            

Principal:                    Contact Number:        

Grade/Area Taught:   

Do you have children who attend a public school in any of the parishes identified in the section titled "School District Choices"? Select... Yes No

If yes, provide the name of the district(s) and school(s):

Do you have relatives who are employed in any of the parishes identified in the section titled "School District Choices"? Select.... Yes No

If yes, provide the name of the district(s) and school(s):



** PLACEMENT NOTE
Student Teachers/Interns are placed in teaching environments that will provide them with optimal professional growth. All assignments are made by the Director of Field Experiences in collaboration with the school districts, individual school principals and cooperating teachers. Assignments are made in schools in the Greater New Orleans area that are approved by the State Board of Elementary and Secondary Education. Every attempt will be made to place students in the district requested; however, placement in the requested district is not guaranteed.

**INTERNSHIP NOTE
All internships must be approved by the Director of Field Experiences. Approval is based on the submission of required documents.

Completion of this application does not guarantee eligibility to student teach/intern Fall 2010.

NOTE: You must register for Internship III Spring of 2010 in order to student teach/intern Fall of 2010.

Verify your answers, then click submit below.