University of Delaware Internship Application

Please fill out the form below and hit submit. You will then be able to take the relevant printouts.

Some fields require description/explanation/listings. The max character limit is 255. If you need
more space then please type out the response in the word document and indicate clearly to which
field the response belongs to. Attach this word document with the printouts of your application.

Name:(Lastname, Firstname Middle Initial):
Choose your password (required to get the printout of this form which you have to sign and submit):

 
Home Address
Street:
City:
State:
Zip:
Home Telephone Number:

 
E-mail Address:

 
Local Address
Street:
City
State:
Zip:
Local Telephone Number:
   
Current Employer
  
Name:
Address:
Job Title / Position:
If teaching, list subject(s) and grade level(s):
   
Select the area in which you expect to intern. All internship experiences are at least a semester long. Students in half-day internships must intern for a minimum of a full school year.

Please select the semester and year of internship.
Are you in the MPCP program (Masters Plus Certification Program)?

 
Preference for Internship Placement
 
 
First Choice
 
District:
School:
Grade Level:
 
Second Choice
  
District:
School:
Grade Level:
 

Please specify the length of your internship:
Please specify your test scores
  
Overall graduate GPA (for all courses taken):
GPA in major:
Praxis I R:
Praxis I W:
Praxis I M:
 

Are there any extenuating circumstances or information we should know about in regard to your internship semester/year? (These "extenuating circumstances" include courses taken while interning, jobs, home conditions, etc)

If "yes" write an explanation:
 
If you currently have any relatives working in the district where you will be interning, please indicate where they are working.
Name:
Office/Building:
Job Title:
Relationship:
 
 
If you currently have any relatives attending school in the district where you will be interning, please indicate where they are working.
School:
Grade:
Relationship:
 
Please list any work experience(s) you have had with children/youth. Add additional listings as needed.
Organization:
Job Title / Position:
Length of Assignment:
Age Group:
Description of your work with children / youth:
Additional Listings:
 
Please list any volunteer experience(s) you have had with children/youth. Add additional listings as needed.
Organization:
Title / Position:
Length of Assignment:
Age Group:
Description of your work with children / youth:
Additional Listings:

After you click "Submit", you will be taken to a page where you can retrieve the data you entered to get a printout of the form.