Undergraduate Internship Application Instructionseducation.ucf.edu/clinicalexp/docs/UndergradApp_Orange.pdf · Undergraduate Internship . Application Instructions . Your completed

Undergraduate Internship

Application Instructions

Your completed application will consist of 3 packets. The contents and order of each packet are listed below. Follow the instructions carefully to ensure that all forms are complete.

When complete, print out this entire PDF document, the pages will print out in the correct packet order. You must fill in ALL required fields for application to be considered complete and reviewed for approval.

No handwritten applications will be accepted.

Staple each packet separately, THEN paperclip the 3 packets together to make one complete packet.

All packets, complete with faculty advisor signature, are due to the Office of Clinical Experiences in ED110

No later than February 15, 2013 at 5PM.

NOTE: YOU WILL NOT BE ABLE TO ELECTRONICALLY SAVE YOUR APPLICATION. KEEP COPIES OF YOUR PACKETS. APPLICATIONS SUBMITTED WITHOUT ALL THE NECESSARY DOCUMENTS COMPLETED WILL NOT BE APPROVED.

************************************************************************************************************************ PACKET #1

1: Application page:

Please plan for enough time to complete as this document requires your faculty advisor’s signature. 2. Summer Contract: If needed: contract must list classes to be taken over summer; required for internship eligibility 3: District Placement Sheet 4: School Placement Sheet 5: Autobiography:

Your autobiography must be limited to one typed page without a cover sheet. See attached example of a model autobiography. School districts may reject your application if your autobiography includes inappropriate content or spelling and grammar errors.

6: UCF Disclosure of Background Sheet 7: Security Packet:

These are legal documents, therefore, be sure to read and complete forms thoroughly, paying close attention to signatures, dates and check boxes. Attach any additional documents if applicable.

8: Degree Audit from myUCF: Make sure all section are opened to show courses taken/not taken.

PACKET #2

1: Copy of District Placement Sheet 2: Copy of Autobiography 3: Copy of UCF Disclosure of Background 4: Copy of Security Packet (Only Required for Orange, Seminole, and Brevard counties)

PACKET #3

1: Copy of School Placement Sheet 2: Copy of Autobiography

Undergraduate Internship Application District:

Home Campus: __________________________

Major: Internship Semester: __________________ Internship Type: Internship I )nternship II PID:

Name: Phone:

Address:

Knightsmail:

Ethnicity (optional): ______________________________________________________ Gender (optional): ______________________

Emergency Contact Name and Phone:

Medical conditions (optional): _______________________________________________________________________________________________

TEACH Grant recipient: YES NO

Be considered for placement at Florida Virtual School (Secondary Only):

Faculty Checklist – Please check all requirements that have been met by the student, including current registration.

Summer Contract attached (for use with fall applications ONLY) Common Program requirements General Education requirements Internship prerequisites (See program information in catalog for further details) Overall grade point average at 2.5 or above (2.75 for Early Childhood)Professional grade point average at 2.5 or above (2.75 for Early Childhood)Specialization grade point average at 2.5 or above (2.75 for Early Childhood) GKT and/or CLAST completed AND reflected on audit Completed Graduation requirements (Filed Intent to Graduate, Professional & Subject Area Tests)

Faculty Notes:

Faculty Signature: Date:

Applicant Acknowledgement I certify that the information provided in this application is complete and accurate and I hereby agree to abide by the policies, rules, and regulations of the University of Central Florida. I authorize the release of my application materials (excluding degree audits) to school district officials as part of my internship application. I understand that it is my responsibility to meet the eligibility requirements for internship. I understand that if my submitted materials are not complete, my application will not be processed. I understand that the official approval is determined by the Director of the Office of Clinical Experiences and that placements are final and non-negotiable. I further understand that I must register myself before the University’s add/drop deadline for the internship course and all required co-requisites. I understand not to fingerprint for the district until formally notified. I understand fingerprinting outside the approved timeline may result in the termination of my internship. I understand that a school district may reject my application for failure to include necessary documentation. Finally, I understand that I may be required to start my internship during the district’s pre-planning week, which is earlier than the UCF academic calendar.

_______________________________________ _____________________________________ ___________________________

Print Sign Date

For Administrative use only: Approved Ineligible Pending Dropped Incomplete Notes: Approval Signature:

College of Education Office of Clinical Experiences P.O. Box 161250 Orlando, Florida 32816-1250 407-823-2518 FAX: 407-823-3728

An Equal Opportunity and Affirmative Action Institution

Orange

Yes No

College of Education

P.O. Box 161250 Orlando, Florida 32816-1250 407-823-2518 FAX: 407-823-3728 An Equal Opportunity and Affirmative Action Institution

College of Education

Internships

Summer Registration Contract

I, ____________________________________, PID ________________,

(Print name)

will enroll in and successfully complete with a grade of C- or better the following Summer ______

Year

courses in order to be eligible for Internship I / II (circle one) in Fall______.

Year Reminder: a minimum GPA of 2.5 is required in professional preparation, specialization, and overall.

Summer Courses (not to exceed 14 hours)*:

* If more than 14 credits are required, you will not be eligible for internship. See your advisor for further information.

Please initial the following statements:

_____ My internship placement(s) will not be confirmed until successful completion of the

courses listed above.

_____ I understand that I cannot enroll in additional courses during my internship semester

unless approved by the program coordinator.

_____ I understand that I must satisfactorily complete all required courses prior to

Internship II.

Student signature: ______________________________________ Date: _______________

Advisor Signature: _____________________________________ Date: _______________

Office of Clinical Experiences




Placement Sheet – District

Major: Internship Semester: __________________

Internship Type: Internship I Internship II

Name: Phone:

Address:

Knightsmail:


Emergency contact Name and Phone:


List all schools in which you have completed field experiences and/or internship, semester completed and corresponding course:

School :__(Example)_Bonneville ES________ Semester: _Spring 2010 Course: ____EDG 4410____ School :__(Example)_Lawton ES ___________ Semester: _Fall 2010 Course: ____EDE 3942____ School: _________________________________________ Semester: _________________ Course: _____________________ School: _________________________________________ Semester: _________________ Course: _____________________ School: _________________________________________ Semester: _________________ Course: _____________________

List below your school choices* for placement: Grade Preference (Secondary and K-12 interns only):

School: ____________________________________________ Elementary (K-5) Middle (6-8) High (9-12) School: ____________________________________________ School: ____________________________________________ Class Preference (ESE interns only):

Autism EBD PMD SLD TMD VE Are you a school district employee? Yes No If Yes, please list the district and school: Employee ID#:

Do you have an arrest record? Yes No **If Yes, a handwritten statement along with all pertinent court documents are required to be submitted with packets #1 and #2 of your application. Please note that certain arrests may result in being disqualified to be cleared in a district. Placement will only be secured after the district has verified appropriate clearance.

Special Needs: Use the space below to list any special needs that may affect your placement. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ *School choices are not guaranteed and depend on availability, as well as principal and district approval. Students may not be placed in schools where they are currently employed.

Applicant Signature Date

Approval, Director of Clinical Experiences Date

Orange



Undergraduate Internship District:

Placement Sheet - School

Major: Internship Semester: ___________________


Name: Phone:

Address:

Knightsmail:



School:__(Example)_Bonneville ES________ Semester: _Spring 2010 _ Course: ____EDG 4410____ School:__(Example)_Lawton ES ___________ Semester: Fall 2010 Course: ____EEX 3942_____ School: _________________________________________ Semester: ___________________ Course: _____________________ School: _________________________________________ Semester: ___________________ Course: _____________________ School: _________________________________________ Semester: ___________________ Course: _____________________

Are you a school district employee? Yes No

If Yes, please list the district and school:




Orange

University of Central Florida INTERNSHIP APPLICATION

Disclosure of Background Information

Name Last First Middle

I understand that my internship experiences shall be completed in local Central Florida school districts. I also understand that I am subject to the rules/regulations of the school and the county in which I am placed. I am aware that the school system has the right to do a personal background check. I also understand that if I have been arrested for or charged with certain crimes, I may not be able to be placed as an intern or hired as a teacher.

Have you ever (as a juvenile or an adult) at any time been arrested and/or convicted, pled nolo contendere (no contest), had a record sealed or expunged, been placed on probation, enrolled in a pre-trial diversion program, or had adjudication withheld in a criminal offense, felony, misdemeanor or otherwise, and/or are there any criminal charges now pending against you other than a non-criminal traffic violation?

YES NO

If YES, attach: 1. A handwritten statement outlining the offense, the court’s decision, and your compliance with the judgment.2. A copy of the arrest record.3. A copy of any court records.4. A copy of probation release, if applicable.5. A copy of fines paid, if applicable.

Be advised: If you have been arrested for or charged with certain crimes, you may not be able to be placed as an intern or hired as a teacher:

Adult abuse, neglect, or exploitation of aged persons or disabled adults

Abuse, aggravated abuse, or neglect of an elderly person or disabled adult

Aggravated assault Aggravated battery Aiding in an escape Aiding in the escape of juvenile inmates in

correctional institutions Arson Assault, if the victim of the offense was a

minor Battery, if the victim of the offense was a

minor Battery on a detention or commitment facility

staff Carrying a child beyond the state lines with

criminal intent to avoid producing a child at a custody hearing or delivering the child to the designated person

Child abuse, aggravated child abuse, or neglect of a child

Contributing to the delinquency or dependency of a child

Contraband introduced into detention facilities Depriving a law enforcement, correctional, or

correctional probation officer means of protection or communication

Drug abuse prevention and control, only if the offense was a felony or if any other personinvolved in the offense was a minor

Encouraging or recruiting another to join acriminal gang

Exhibiting firearms or weapons within 1,000 feet of a school

Exploitation of an elderly person or disabled adult, if the offense was a felony

False imprisonment Fraudulent sale of controlled substances, only

if the offense was a felony Harboring, concealing, or aiding an escaped

prisoner Incest Inflicting cruel or inhuman treatment on an

inmate resulting in great bodily harm Introduction of contraband into a correctional

facility Kidnapping Killing of an unborn child by injury to the

mother Lewd and lascivious behavior Lewd or lascivious offenses committed upon

or in the presence of an elderly person or disabled adult

Lewdness and indecent exposure

Manslaughter, aggravated manslaughter of an elderly person or disabled adult, or aggravated manslaughter of a child

Murder Negligent treatment of a child Obscene literature Possessing an electric weapon or device,

destructive device, or other weapon on schoolproperty

Prohibited acts of persons in familial or custodial authority

Prostitution Resisting arrest with violence Sexual battery Sexual misconduct in juvenile justice

programs Sexual performance by a child Taking, enticing, or removing a child beyond

the state limits with criminal intent pending custody proceedings

Theft, robbery, and related crimes, if the offense is a felony

Vehicular homicide

(See Appendix of the Student Teaching Handbook for further information.)

I understand that this form, along with supporting documentation, will be submitted to the county office for review and final approval.

Applicant’s Signature

PLEASE ATTACH FULL DEGREE AUDIT FROM myUCF HERE

Click link for instructions on how to view and print your degree audit:

http://registrar.ucf.edu/pdf/UCFStudentHelpGuideforDARSDegreeAudits.pdf

Make sure all section are opened to show courses taken/not taken.






Placement Sheet – District

Major: Internship Semester: __________________


Name: Phone:

Address:

Knightsmail:





School :__(Example)_Bonneville ES________ Semester: _Spring 2010 Course: ____EDG 4410____ School :__(Example)_Lawton ES ___________ Semester: _Fall 2010 Course: ____EDE 3942____ School: _________________________________________ Semester: _________________ Course: _____________________ School: _________________________________________ Semester: _________________ Course: _____________________ School: _________________________________________ Semester: _________________ Course: _____________________

List below your school choices* for placement: Grade Preference (Secondary and K-12 interns only):

School: ____________________________________________ Elementary (K-5) Middle (6-8) High (9-12) School: ____________________________________________ School: ____________________________________________ Class Preference (ESE interns only):

Autism EBD PMD SLD TMD VE Are you a school district employee? Yes No If Yes, please list the district and school: Employee ID#:

Do you have an arrest record? Yes No **If Yes, a handwritten statement along with all pertinent court documents are required to be submitted with packets #1 and #2 of your application. Please note that certain arrests may result in being disqualified to be cleared in a district. Placement will only be secured after the district has verified appropriate clearance.




Orange

University of Central Florida INTERNSHIP APPLICATION

Disclosure of Background Information

Name Last First Middle

I understand that my internship experiences shall be completed in local Central Florida school districts. I also understand that I am subject to the rules/regulations of the school and the county in which I am placed. I am aware that the school system has the right to do a personal background check. I also understand that if I have been arrested for or charged with certain crimes, I may not be able to be placed as an intern or hired as a teacher.

Have you ever (as a juvenile or an adult) at any time been arrested and/or convicted, pled nolo contendere (no contest), had a record sealed or expunged, been placed on probation, enrolled in a pre-trial diversion program, or had adjudication withheld in a criminal offense, felony, misdemeanor or otherwise, and/or are there any criminal charges now pending against you other than a non-criminal traffic violation?

YES NO

If YES, attach: 1. A handwritten statement outlining the offense, the court’s decision, and your compliance with the judgment.2. A copy of the arrest record.3. A copy of any court records.4. A copy of probation release, if applicable.5. A copy of fines paid, if applicable.

Be advised: If you have been arrested for or charged with certain crimes, you may not be able to be placed as an intern or hired as a teacher:

Adult abuse, neglect, or exploitation of aged persons or disabled adults

Abuse, aggravated abuse, or neglect of an elderly person or disabled adult

Aggravated assault Aggravated battery Aiding in an escape Aiding in the escape of juvenile inmates in

correctional institutions Arson Assault, if the victim of the offense was a

minor Battery, if the victim of the offense was a

minor Battery on a detention or commitment facility

staff Carrying a child beyond the state lines with

criminal intent to avoid producing a child at a custody hearing or delivering the child to the designated person

Child abuse, aggravated child abuse, or neglect of a child

Contributing to the delinquency or dependency of a child

Contraband introduced into detention facilities Depriving a law enforcement, correctional, or

correctional probation officer means of protection or communication

Drug abuse prevention and control, only if the offense was a felony or if any other personinvolved in the offense was a minor

Encouraging or recruiting another to join acriminal gang

Exhibiting firearms or weapons within 1,000 feet of a school

Exploitation of an elderly person or disabled adult, if the offense was a felony

False imprisonment Fraudulent sale of controlled substances, only

if the offense was a felony Harboring, concealing, or aiding an escaped

prisoner Incest Inflicting cruel or inhuman treatment on an

inmate resulting in great bodily harm Introduction of contraband into a correctional

facility Kidnapping Killing of an unborn child by injury to the

mother Lewd and lascivious behavior Lewd or lascivious offenses committed upon

or in the presence of an elderly person or disabled adult

Lewdness and indecent exposure

Manslaughter, aggravated manslaughter of an elderly person or disabled adult, or aggravated manslaughter of a child

Murder Negligent treatment of a child Obscene literature Possessing an electric weapon or device,

destructive device, or other weapon on schoolproperty

Prohibited acts of persons in familial or custodial authority

Prostitution Resisting arrest with violence Sexual battery Sexual misconduct in juvenile justice

programs Sexual performance by a child Taking, enticing, or removing a child beyond

the state limits with criminal intent pending custody proceedings

Theft, robbery, and related crimes, if the offense is a felony

Vehicular homicide

(See Appendix of the Student Teaching Handbook for further information.)

I understand that this form, along with supporting documentation, will be submitted to the county office for review and final approval.

Applicant’s Signature



Undergraduate Internship District:

Placement Sheet - School

Major: Internship Semester: ___________________


Name: Phone:

Address:

Knightsmail:



School:__(Example)_Bonneville ES________ Semester: _Spring 2010 _ Course: ____EDG 4410____ School:__(Example)_Lawton ES ___________ Semester: Fall 2010 Course: ____EEX 3942_____ School: _________________________________________ Semester: ___________________ Course: _____________________ School: _________________________________________ Semester: ___________________ Course: _____________________ School: _________________________________________ Semester: ___________________ Course: _____________________

Are you a school district employee? Yes No

If Yes, please list the district and school:




Orange

Documents

Undergraduate Internship Application Instructionseducation.ucf.edu/clinicalexp/docs/UndergradApp_Orange.pdf · Undergraduate Internship . Application Instructions . Your completed