UNION, NJ07083

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




(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: _____________________________________________________________ †††††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††



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.†††††††††††††† Supervisorís 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



___________________________________________††††††††††††††††††† _______________________

Studentís 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