Early Care & Education/Non-Licensure
Final Internship Placement Request Form
Final Internship Semester:
Fall__________
Spring _______
________________________________________________ ID# ________________________
(Name-Last)
(First)
______________________________________________________________________________
(Address-Local)
______________________________________________________________________________
(Phone numbers – all of them where you can be reached currently or during the summer)
Email_____________________________________
Date_____________________
Advisor___________________________________
_____ I
am an on campus student
___I am a student in the online degree completion program
On-Campus Students:
You will be placed in the Child Care Education Program on campus for your final
internship. If you have a preference for a particular classroom, please indicate
your 1st, 2nd, and 3rd choices. If not, leave blank.
______
Carter Center (toddlers- 15-28 months)
______
North Drive 1 (older toddlers, mostly 2’s and some 3’s)
______
North Drive 2 (younger preschoolers, mostly 3’s)
______
Curry 205 (older preschoolers, mostly 4’s and some 3’s)
______
Curry Annex (widest range of preschoolers, 3-4)
______
Infants (4-15 months)
Online Students:
Online students will be placed at an appropriate 4 or 5 star rating center with a
cooperating teacher who has a 4 year degree in early childhood. Please indicate
below your top 2 choices of centers and ages. Please include the address of the
center, the name of the teacher, and age level (if you know).
1)_______________________________________________________________
________________________________________________________________
_________________________________________________________________
2)_______________________________________________________________
_________________________________________________________________
_________________________________________________________________
***Note: If the Program in which you will be working is open during fall or
spring break you are expected to work your student teaching schedule for that
week.
List other classes will you be taking along with your final internship:
Indicate the instructor you had for the following courses, the school/classroom in
which you performed your practicum hours for the course, and the term the course
was taken (or is planned):
Instructor
Placement Site
Term Taken
340/420 Practicum 1 ______________________
______________________
___________
440 Practicum 2
______________________
______________________
___________
425 Infant/Toddler
______________________
___________
435 Preschool
______________________
___________
Please return this Form to Ms. Maggie Jones, HDF office, 248 Stone Bldg.
These can be returned in person, faxed to 336-334-5076, or attached and
emailed to: mmjones3@uncg.edu
If you have any questions about your internship, contact:
Ms. Stradley Smith, 148 Stone
336 334-5307
email: gssmith@uncg.edu
Revised 10/12