Michigan State Universityteacher Preparation Program

Michigan State UniversityTeacher Preparation Program

SPECIAL EDUCATIONINTERNSHIP PLACEMENT PLAN

*This Internship Placement Plan will need to be completed onlineby way of a link sent to your email ANDyou will also need to complete a print copy of this plan to be handed in to Lisaby All Spec. Ed.Interns!!

*A copy of the print form will need to be handed in at the meeting or to Lisa Plascencia in 336 Erickson Hall - Due by Wednesday, Nov. 22nd, 2017!!

CONTACT INFORMATION

Name______Certification area: __ Learning Disabilities__

PID#______Email______

Phone: Local______Cell______Permanent______

Current Address:______

Internship Year Address:______

Summer Address: ______

B. PLACEMENT PREFERENCES FOR 2015-2016 INTERNSHIPS

Please mark appropriate preference with 1 for first priority, 2 for second priority, etc.

Major(s):______/______

and/or Minor(s):______/______

Are you anUECP or GECP member? _____No _____Yes- Please List your Cohort______

If you have been employed, or you have relatives/significant others* who are employed in schools in the areas you indicated above, please explain your relationships to the person, the position held, the school and the district:

______

What K-12 schools, if any, did you attend in your preference area?______

Do you have children enrolled in schools in the area you requested? If so, what school(s)?______

OTHER? Please write any other important consideration in making your placement on a separate attachment.

C. SIGNATURE

I acknowledge that I have received and read a copy of the Intern Placement Policies. I acknowledge that MSU will attempt to honor my preferences but CANNOT GUARANTEE a placement that closely matches those preferences. I understand that MSU does not permit teacher candidates to make their own placements. I understand that it is my responsibility to meet all the eligibility requirements prior to the internship.

*SIGN AND RETURN THIS FORM TO Lisa Plascencia, 336 Erickson Hall- DUE BY NOV. 22, 2017.

______

(Signature)(Date)

D. DELAYING YOUR INTERNSHIP YEAR OR DROPPING THE PROGRAM

My declared internship year is______.

______I will not be interning in the year I originally declared. I am delaying my internship until ______, because

______Personal reasons (e.g. financial needs, medical needs, travel, exploring other options, personal preference, etc.)

Please explain:

______Academic extension (e.g. need to finish teacher education coursework, major/minor courses, or degree requirements)

If you have not already done so, please meet with an academic advisor about your extension.

I understand that if I am requesting another internship year other than the one I declared, I will be required to fill out a REQUEST TO CHANGE INTERNSHIP YEAR form. This request form is on the College of Education website at

Please complete the form and return it to the Student Affairs Office, 134 Erickson Hall as soon as possible.

I understand that the Department of Teacher Education will review this request to change my internship year and that the Teacher Education Department cannot guarantee that my request will be approved. I understand that if my request is rejected, I can file an appeal.

I understand that if I delay my internship due to reasons other than academic extension, I may be required to submit a REQUEST FOR REINSTATEMENT TO THE TEACHER PREPARATION PROGRAM when I am ready to return for the internship year. This form can also be found at the above website.

______I am dropping the Teacher Preparation Program. I understand that I must write a letter to the pre-internship coordinator, Andrea Kelly, with a copy sent to the College of Education Student Affairs Office stating that I am dropping the Program or I will complete a withdrawal form in the Student Affairs Office, 134 Erickson Hall.

(Signature) (Date)

*Relatives/significant others means a connection between persons by blood, marriage, adoption, domestic partnership, or other personal relationship in which objectivity might be impaired.