Early Childhood Education: Infant to Grade 4
Internship Request Form
All Internship placements must be cleared through the Early Childhood Department
Internships will be in birth to Kindergarten classrooms
Attach an unofficial transcript to request
Only one lab course may be taken along with Internship
Students planning to register for Spring Internship must submit a request form by Thanksgiving
Students planning to register for Fall Internship must submit a request form by mid April
You will receive a confirmation letter which includes your internship placement, week 1 assignment and an
Internship Manual
Pre-req of EARL 106,107,126,128,208,216,217 all with a grade of C or better. Pre or co-req of 218 and 244
Name: ______________________________________________
Address: ____________________________________________
Phone: ______________________________________________
Email: ______________________________________________
I am enrolled at: ___Bethlehem ___Monroe ___On Line (6 or more ECE courses -18 credits - were completed online)
I am requesting Internship for: _________Semester__________Year
I request placement with: ___Infants ___Toddlers ___Preschool ___Kindergarten ___Head Start
City of Preference: _______________
I expect to graduate in: ____Spring ____Winter _____ Year
I expect to receive: ____ Associate degree ____ Certificate
I have an up to date TAOC E-Portfolio and a hard copy (you will be required to bring your hard copy TAOC
portfolio on the first day of class): ____Yes ____No
Upon graduation from NCC I plan to:
___Teach infant to preschool
___Transfer to bachelor degree program for Pre-K Certification ___Full time ___Part time
If transferring: Intended college(s) _________________________________________
PAPA Exam: Passed _______ Retaking: date ________ Plan on taking: date _______
G:\Early Childhood\Curriculum\Forms\Internship Request Form FA13.doc
Internship Placement Location Request
You may request an internship site. All Internship preschool centers are expected to be enrolled in a state
sponsored Quality Assurance Rating program and/or accredited. If you are employed at the site, you must be
have worked there for six months or more. In addition, the qualifications of the cooperating teacher must meet
the Quality Assurance lead teacher requirements for the state or those outlined in the student manual. A
request does not mean that you will be placed at this site. Worksite internship placement will require
department approval. If not currently employed online students must select a STAR 3 or STAR 4 site.
Students will be eligible to be placed at NCC Children’s Centers if they have been an employee for 6 months or
more.
*Online Students: When sending your request include quality assurance requirements for your state for lead
teachers.
Name of School/Center: _________________________________________
If in PA: Site is a PA STAR Level ____1____2____3____4____Accredited (NAEYC or MSCES)
Site does not participate in any quality assurance system____
If in a state other than PA:
____Site meets the quality standards in ______ (name of state) at the ________quality level.
____State does not have a Quality Assurance Rating Program.
Reason for request: ___employment ___transportation ___other (describe) ______________________
If employed: ___number of hours per week ____years working at the school/center (minimum 6 months)
Address:
___________________________________________
___________________________________________
Phone:
____________________________________________
Director:
____________________________________________
Director Email:
____________________________________________
Cooperating Teacher: ___________________________________________
Cooperating Teacher Email: _______________________________________
Cooperating Teacher Meets Eligibility Requirements (refer to guidelines in the Student Manual): ___Yes
Site will allow videotaping of lab work: ___Yes
Site will sign UOP with NCC: ___Yes
Age Group: ___Infants ___Toddlers ___Preschool ___Kindergarten
G:\Early Childhood\Curriculum\Forms\Internship Request Form FA13.doc
Early Childhood Education Academic Form
Course
Section
Title
EARL106
Early Childhood Development and Learning
EARL107
Observation and Assessment
EARL126
Arts in Early Childhood
EARL128
Infant/Toddler Development and Learning
EARL208
Math in Early Childhood
EARL216
Language and Literacy in Early Childhood
EARL217
Child, Family and Community
EARL218
Science in Early Childhood
EARL244
Early Childhood Profession
Credit for CDA: ____Yes
Final Grade or Planned
Completion Date
____No If yes, how many? ____
Assigned Placement Site: _________________________________________________________
Faculty Signature: _______________________________________________________________
G:\Early Childhood\Curriculum\Forms\Internship Request Form FA13.doc