Fill - Free fillable MAT Internship APP 3.18.19 - MAT Internship APP 3.18.19 PDF form

Revised 3.18.19

INSTRUCTIONS FOR COMPLETING INTERNSHIP APPLICATION

MASTERS OF ARTS IN TEACHING

Applications are due in the office of the Director of Teacher Education Student Services on

October 1

for Spring Semester and March 1

for Fall Semester

Please read and follow ALL of these instructions carefully.

1. ____Set up an appointment with your advisor.

2. ____Go to OneTech, sign in, click on student tab, follow the menu, PRINT a copy of your ATU Transcript. Do not go to the

registrar’s office and do not go to your advisor for a copy of your ATU transcript. If you have transfer work, you will

need an unofficial copy of ALL TRANSFER WORK. You will also need an APPROVED COPY of your degree audit and any

waivers you may have.

3. ____Take the following forms with you for your appointment with Dr. Lynn Walsh.

a. MAT Internship Application

b. Unofficial ATU transcript and if applicable, a transfer graduate transcript.

c. Copy of your approved Candidacy Form

4. ____Complete the Field Experience Review Form. This form will help ensure that you receive diversity in your placement.

5. ____Take all of the completed forms mentioned above with you to your appointment.

6. ____Set up an appointment with Teresa Auprey (tauprey@atu.edu) to complete your fingerprinting for your AELS

background check.

IMPORTANT INFORMATION

The College of Education must have received from PRAXIS a DESIGNATED INSTITUTION SCORE REPORT with passing Core

Academic Skills for Educators Tests Praxis I and Praxis II Content Knowledge Score(s) prior to the first day of the semester.

Be sure to have your score(s) report(s) sent to both ATU (code #RA6010) and the State Department of Education (code

#R7031). Failure to do this will result in an additional fee for requesting duplicate scores and will slow the processing of your

application.

The Arkansas Department of Education requires an APPROVED BACKGROUND CHECK before entering an internship. This

consists of fingerprinting which must be approved by both the Arkansas State Police and the FBI. It also requires an approved

Child Maltreatment form. Please contact the Office of Licensure and Support Services in Crabaugh 310 for more information.

You may also email Teresa Auprey at tauprey@atu.edu or call her at 479-964-0583 ext. 2351. It can take up to two months to

gain this approval. Please allow sufficient time for approval so your entry into internship won’t be delayed.

The Office of The Director of Teacher Education Student Services will notify you, by OneTech e-mail, of your status (usually

after the end of the current semester) and arrange for your placement (if not employed by a school district). Do not contact

schools until your placement is confirmed by this office.

Revised 3.18.19

MASTERS OF ARTS IN TEACHING INTERNSHIP APPLICATION

Issued for the Semester: _______________________

To Be Completed by Intern

This application must be complete to be considered for admission into MAT Internship.

Last Name _______________________________ First Name _____________________________ Middle Name____________________

Maiden _________________________ SS# ________________________ T #______________________ Birth Date _________________

OneTech Email ____________________________________ Address ____________________________________________________

City ______________________________ State ______ Zip _________ Phone # ____________________ Cell #____________________

Have you ever been convicted of a felony? Yes_____ No_____

Enter the date of your electronic fingerprinting. Date _______________________

Candidate Signature __________________________________________________________ Date ___________________________

To Be Completed by MAT Advisor Dr. Lynn Walsh

Grade Point Average: _________________ Cumulative (including all transfer work): __________________

If the candidate has not completed the Core Academic Skills for Educators Tests and PRAXIS II Content Knowledge Test(s), when does

the candidate plan to take or retake the test(s)?

________________________________________________________________________________________________________________

Praxis II Score(s) Spec. Name ____________________________________________________________ Score ____________________

Recommended by Dr. Lynn Walsh ________________________________________________________ Date ____________________

To Be Completed by Director of Teacher Education Student Services

Praxis II Content Knowledge Test Name: ___________________________________________________ Score:_________________

Approved _______________________________________________________________ Date _________________________________

Denied _________________________________________________________________ Date _________________________________

Reason _________________________________________________________________________________________________________

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Revised 3.18.19

Arkansas Tech University

Teacher Education Program

Field Experience Review Form for MAT Internship Placement Form

(The information provided will be used to make appropriate pre-service placements in the field. Placements are the administrative

decision of the College of Education through the Director of Teacher Education Student Services and are final.)

Last Name ____________________________ First Name ___________________________ Middle Name______________________

Maiden ______________________________ SS# ____________________ T #___________________ Birth Date ____________

OneTech Email _________________________________ Address _________________________________________________

City ______________________ State ____ Zip ___________ Phone # _____________________ Cell #___________________

What is your major field? Check one of the following:

MAMS – MLED – Check two below

Math ______

English ______

Science______

Social Studies ______

MAMS - Secondary

Agri Ed ______ Health and PE K-12 ______

Art K-12 ______ Life Science ______

Business ______ Mathematics ______

Chemistry ______ Music Instrumental ______

Creative Writing ______ Music Vocal ______

English ______ Physical Science ______

Foreign Language – French ______ Physics ______

Foreign Language – German ______ Social Studies ______

Foreign Language – Spanish ______ Speech ______

Are you currently employed by a school district as a teacher? Yes _____ No _____. If yes, please provide the following information:

School Name________________________________________ School District________________________________________

School Address ______________________________________ Subject/Grade Teaching________________________________

Supervisor’s Name____________________________________ Supervisor Contact ____________________________________

If no, please fill out the remainder of this form. If yes, you will not need to fill this out.

Do you have relatives currently employed by a public school? Yes _____ No _____ If yes, complete the following:

Name

Relationship to You

District

School/Grade level

Do you have children attending public school? Yes _____ No _____ If yes, complete the following:

Name

Relationship to You

District

School/Grade level

Revised 3.18.19

Describe any related work experience you have completed in the last 2 years:

________________________________________________________________________________________________________________

List any minors and the courses you will have completed for areas of endorsement:

________________________________________________________________________________________________________________

Describe any limitations/disabilities/special considerations that may affect an appropriate placement:

________________________________________________________________________________________________________________

Please list three school districts for consideration as the Director of Teacher Education seeks your appropriate placement.

You may not include the school at which you have children attending or relatives employed. You may, however, request any

public school district in Arkansas. YOUR CHOICES ARE A STATEMENT OF PREFERENCE ONLY.

School District for Consideration

Choice __________________________

Comments

________________________________________________________________________________________________________________

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