Secondary School Subjects: Biology, Chemistry, English, Math, Social Studies - Grades 9 - 12
Music, Art, TESOL- Grades K - 12
This application, a resume and a student checksheet are due to the Office of Field Experiences, by the following deadlines:
Last Friday in September for Spring internships
Last Friday in February for Fall internships
Keep a copy of all completed forms in your own files!
The MAT Internship is a full-time, one-semester commitment. The intern is placed in a school with a cooperating teacher who has agreed to serve as host for the experience. The exact dates for beginning and ending the internship will be worked out with the intern, the cooperating teacher and the WCU supervisor. Ideally, the intern will know the placement in advance and will be able to spend some time observing the cooperating teacher and other teachers in the same school prior to beginning. Details about intern responsibilities are given on the internship information packet.
Dr. Herzog Homepage & Email
MAT General Information
Cut along line:
Semester/year for internship to take place:
Name (Last, First, Middle)
Student ID Number 92
Concentration & Licensure Area
WCU email address
WCU students are required to use WCU email for program communications
Personal email address
Home Mailing Address
Home Numbers - Telephone/cell/fax
Employment (Contact Information, Name &Telephone/Fax Number, etc.)
District, School and Host Teacher Preferences
1
2.
3.
If applicable, give the name and contact information of a particular teacher who has indicated a willingness to host your internship.
(It is not guarantee
Expected date to complete other MAT or licensure requirements
Teacher Work Sample MAT Graduation Portfolio PRAXIS II
1. Have you ever had a certificate or license to teach or otherwise supervise minors revoked or suspended by any state or other governing body? If yes, attach a statement giving full details and official documentation of the action taken.
__________ Yes __________ No
2. Have you ever been convicted of a crime (excluding minor traffic violations)? If yes, attach a letter of explanation and a certified copy of the court disposition. Students will also need to submit a background check to the host school once placement has been made.
__________ Yes __________ No
Neither the State of North Carolina nor Western Carolina University will be responsible for providing legal defense for any professional education candidate or for paying for any judgment which may be entered against the accused; therefore, the College of Education and Allied Professions strongly encourages all professional education candidates to purchase professional liability insurance.
I have read all the materials, including the catalog under which I entered WCU, concerning the policies and procedures for eligibility and admission to internship. I understand my responsibilities related to admission and completion of the internship program. Should I withdraw from, or fail, any required course, I understand that I am not eligible for the internship program and that I will be withdrawn from placement.
Student's signature Date
Advisor's signature Date
Include your resume and completed student checksheet with this application. Return form to: Office of Field Experiences and Licensure • Western Carolina University • Killian 228 • Cullowhee, North Carolina 28723 • (828) 227-7314