Early Care & Education/Non-Licensure
Final Internship Placement Request Form
Final Internship Semester:
ID#
(Name-Last)
Fall
Spring
_/
/
(First)
(Address-Local)
(Phone numbers – all of them where you can be reached currently or tracked down 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 your top 2 choices of centers and ages. Please include the address of
the center, and the name of the teacher and age level (if you know that).
Centers: 1)
_
2)
_
_
_
***Note that the Program in which you will be working is open during fall and
spring break and that 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
340 Practicum 1
440 Practicum 2
425 Infant/Toddler
435 Preschool
Placement Site
Term Taken
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 scanned 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 10/13