TEACHING PERFORMANCE CENTER

KEAN UNIVERSITY

COLLEGE OF EDUCATION

WILLIS 110

UNION, NJ  07083

Telephone (908) 737-4185 - Fax (908) 737-4115

e-mail:  tpc@kean.edu

 

APPLICATION FOR VISITING PROFESSIONAL INTERN

(Incoming Student)

 

Applying for Semester _____________________   Year _____________________

(Application must be submitted a minimum of 6 months prior to requested semester)

 

I.          Personal/Professional Data

 

Name:__________________________________________      S.S.#:__________________

(Last Name)                                   (First Name)

 

Street Address: _____________________________________________________________                                                                                                   

City:____________________________  State:_____________  Zip:__________________

                                               

Phone:  (Home)_______________  (Work)_________________ (Cell) ________________

 

Email: _________________________________________________________________                    

Professional Specialization: ________________________________________________                                                                                      

Program:(circle one)      Undergraduate     Post-bac Certification        Graduate

 

Cumulative GPA:______________ Professional Course Work GPA: ________________

                       

Currently Attending College/University:_______________________________________

 

            Is this an NCATE Accredited Institution?:   ____ Yes  ____ No                                                                     

                       

II.         Additional Documentation

 

1.      Attach a brief description surrounding the circumstances necessitating this special request for an out-of-state student teaching/internship experience.

 

2.      Attach a one-page typed autobiography to be shared with your cooperating teacher, principal and district.  Your background, philosophy and other information should be shared.

 

3.      Attach a letter of support of a strong record of performance in your educational field work (e.g., copies of evaluations from field experiences, letter from classroom teacher, etc.).

 

 

 

III.       Praxis Requirement

 

            The College of Education at Kean University requires that all students performing student teaching/professional internship take and pass the respective Praxis II test for their area of certification BEFORE they can begin the professional internship.  Visiting students must meet the passing Praxis II score standards of the state in which they are attending college.  Please submit a photocopy of your Praxis II score report with this application.

 

                       Praxis II Taken:  ___ Yes   ___ No        Passed Praxis II:  ___ Yes  ___ No

 

IV.        Sending College Information

 

Name of Department Chair:____________________________________________________

Address of Department Chair:__________________________________________________

Telephone Number of Department Chair:_________________________________________

FAX Number of Department Chair:______________________________________________

Email Address of Department Chair: _____________________________________________

             

Signature of Department Chair:_______________________________________________

 

V.         Fees

 

I understand that by choosing to perform my student teaching/internship at Kean University I will incur the following expenses beyond normal tuition costs and that my grade in student teaching will be withheld until such fees are paid.

 

1.               Supervisor’s fee (as per union contract)                       $      950.00

2.               Cooperating Teacher Honorarium                                        100.00

3.               Travel Expenses                                                                100.00

4.               Field Placement Fee                                                        1,000.00           

Total Payment Required                                             $ 2,150.00

 

 

___________________________________________                    _______________________

Student’s Signature                                                                      Date

 

 

NOTE: *Application for student teaching is not complete until the Kean University Professional Internship Field Experience Application is completed and submitted to the Teaching Performance Center.  Neither this application, nor the field experience application constitute registration.  Registration must be executed separately by the student at the Office of the Registrar at his/her sending college or university.

 

 

Application must be submitted at least 6 months prior to the requested semester.

 

Return completed application to:           Martha M. Mobley, Ph.D., Director

Teaching Performance Center of Kean University

Willis 110

1000 Morris Avenue

Union, NJ 07083