EASTERN WASHINGTON UNIVERSITY
PRINCIPAL CERTIFICATION INTERNSHIP
COURSE
EDUC 695 or
EDUC 695/601 for Master’s Students
APPLICATION FORMS
TABLE OF CONTENTS
Principal Certification Overview
FORMS A, B, AND C
A. Application for Admission to Internship – Form A
pages 3 – 5
B. District Internship Approval Form – Form B
page 6
C. Principal Certification Reference Forms – Form C
(complete 4 sets)
pages 7-9
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EASTERN WASHINGTON UNIVERSITY
DEPARTMENT OF EDUCATION
PRINCIPAL INTERNSHIP OVERVIEW
The Eastern Washington University Department of Education is regional in scope, serving the
Inland Empire that encompasses eastern Washington, northern Idaho, western Montana,
northeast Oregon, and southern British Columbia. The Inland Empire includes the major city of
Spokane, scattered urban centers, small towns, and expansive sparsely populated areas.
The Education Department has built and maintained an outstanding reputation for producing
some of the state’s finest teachers and administrators. The Principal Certification Program
prepares educators for leadership positions in public, private, and charter prekindergarten
through grade 12 schools. Upon completing the program, students will have satisfied the
requirements of the Washington State Department of Public Instruction for a school principal’s
certificate. The program endeavors to prepare educators to be effective school leaders whether as
principals, assistant principals, program administrators, or as teachers still in the classroom.
The application materials that follow are for candidates ready to enter the Principal Internship
Course. To be ready to apply for the Principal Internship Course, candidates must have: a
completed, or in-progress, master’s degree in education; a job in a school or school district; a
teacher certificate or Education Staff Associate certificate; three years of teaching experience, and;
completed, or will complete prior to the internship, the five specialized prerequisite courses of the
Educational Leadership Program.
The Principal Internship Course consists of a 10-month program beginning in August and ending
the following June. Candidates work with a mentor principal and the principal internship course
supervisor to fulfill the requirements of the course including a minimum 540-hour internship, half
of which must be during the school day when students, teachers or parents are present. There are
four seminars during the internship that candidates must attend: a two day session in August; one
Saturday in October; and one Saturday in March, and one Saturday in April, as well as assorted
projects and assignments to complete.
Thank you for your decision to apply for this program. You have chosen an exciting, challenging,
and rewarding career!
Dr. Lance Potter, Director of Educational Leadership
Eastern Washington University
Department of Education
313B Williamson Hall
Cheney, WA 99004-2458
Office: (509) 359-7018
FAX: (509) 359-2899
E-mail: rpotter6@ewu.edu
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Form A
EASTERN WASHINGTON UNIVERSITY
DEPARTMENT OF EDUCATION
PRINCIPAL CERTIFICATION PROGRAM
APPLICATION FOR ADMISSION TO INTERNSHIP
1. (Mr.)(Ms.)
(Last)
Address:
(Number & Street)
(First)
(Middle)
(City)
(State)
Home Phone:
Work Phone:
E-Mail:
Cell Phone:
2. When do you expect to complete requirements for this certificate?
3. Do you have a Master’s Degree?
Yes
(Student ID)
(Qtr.)
No Year
(Zip Code)
(Year)
Institution
4. If no, when will you finish the Master’s Degree?
5. Do you hold a Residency or Professional teaching certification?
Years Experience
6. Intern candidates must be employed in a P-12 school setting or have a special exemption approved
by the PEAB to be considered for an internship and must remain in that status during the internship. List your educational service during the past 7 years, starting with the most recent:
Dates
Name of School
School District/City
Grade Position
(1)
(2)
(3)
7. Name of school where internship will be completed:
District
School Address
Principal
Phone
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8.
REFERENCES:
Give complete names, current addresses, and phone numbers of school administrators who have
been your supervisors and to whom you will be giving the four Reference forms. Include references
from positions you have held, listing most recent first. Include superintendents, personnel
directors, and principals. If this poses a problem, please contact the program director.
At least two of the forms must be based on present performance. One reference form must be from
your potential mentor principal or the present district superintendent. (NOTE: References must be
received by April 18th to be considered. Noting addresses below enables us to check off references
as they are received.)
(1)
Name
Title
(2)
Address
Phone
Name
Title
Address
Phone
Name
Title
Address
Phone
Name
Title
Address
Phone
(3)
(4)
9. You must have all course work completed prior to beginning the internship. Courses remaining
that you are taking or will need to take: Course
Quarter
Course
Quarter
Course
Quarter
Any exceptions must be approved by the Director of Educational Leadership. Please submit this
Document by April 18th to the address listed on page 5.
10. The above statements are true and correct.
Signature:
Date:
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11. Attach a letter of application, word-processed, single spaced, and not over two pages in length
which addresses the topics listed below. The letter will be judged by the Administrative
Professional Education Advisory Board (PEAB) on quality of thought, content, clarity of
expression, writing skill, and language usage.
A. Describe why you would like to enter the EWU Principal Certification Program.
B. Express your vision of the principal’s role and your leadership strategies for implementing
improved student performance.
C. Describe school leadership experiences that you have engaged in that are related to school
reform and improving student learning.
D. Discuss your future career goals.
ADDITIONAL IMPORTANT INFORMATION

Submit Forms A and B with your letter of application by April 15th prior to the August that you
plan to begin your internship. Applications may be submitted in paper form, or electronically.
Send application to the EWU Director of Educational Leadership Program (address below).

Complete the “Candidate Section” on each of the four Reference Forms (C) included in this
handbook (be sure to fill in your name). Send the forms to your chosen references well in
advance of the April 15th deadline. It is courteous to include with each letter a pre-addressed
envelope. EWU will provide postage paid envelopes upon request.

Dr. Lance Potter, Director
Educational Leadership Program
Eastern Washington University
Department of Education
313B Williamson Hall
Cheney, WA 99004-2458
rpotter6@ewu.edu
SUGGESTION: Call your references personally to ask permission to use them as a reference and
explain the importance of the April 18th deadline for Form C.
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Form B
EASTERN WASHINGTON UNIVERSITY
EDUCATIONAL LEADERSHIP INTERNSHIP PROGRAM
DISTRICT APPROVAL FORM
TO:
FROM:
DATE:
SUBJECT:
District Superintendent (or Official Designee)
Dr. Lance Potter, Director, Educational Leadership Program
PRINCIPAL INTERNSHIP
is completing the requirements for a Residency
Principal Certificate and is eligible to complete the internship during the
school year.
Your approval and collaboration for the completion of the internship in compliance with, WAC
181-78A-125, include the following:
(1)
appointment of a qualified mentor principal (whose signature appears below).
(2)
your willingness to facilitate time (540 hours), half of which must be completed during the
school day, working with students/staff (A complete listing of duties will be provided for
the mentor principal in a Mentor Principal Handbook.).
(3)
access to activities and experiences deemed essential in the principalship preparation
program by the mentoring principal, the university supervisor, and EWU’s Educational
Leadership PEAB.
(4)
assurance that intern candidates are employed in a P-12 school setting or have a special
exemption approved by the PEAB.
Not Recommended
Recommended with Reservation
Recommended
Highly Recommended
Comments (Use reverse side of this page, or a separate page if needed)
Signature of Superintendent
Date
The internship having been approved, the Mentor Principal appointed by the Superintendent
will be
who has at least three
years experience as a school administrator.
Signature of Mentor Principal
Date
Please return to: Dr. Lance Potter, Director of Educational Leadership, Department of Education, 313B
Williamson Hall, Cheney, WA 99004-2458, or by e-mail to rpotter6@ewu.edu.
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Form C
EASTERN WASHINGTON UNIVERSITY
EDUCATIONAL LEADERSHIP INTERNSHIP PROGRAM
PRINCIPAL CERTIFICATION REFERENCE FORM
Intern Candidate complete this section before submitting this form to your reference:
Dear
:
(PRINT name of person providing the reference)
I have applied for admission to the EWU Residency Principal Certification program and am
required to present references covering the last several years of my educational service. I have
given your name for that purpose. I would appreciate your evaluation of me as an administrative
candidate on the attached form based on our professional contact.
Thank you.
Signature of Candidate
Date
(PRINT name of Candidate)
In compliance with the Family Education Rights and Privacy Act of 1974, this recommendation
will be placed in the applicant’s file and may be reviewed by the individual upon request, unless
this waiver is signed.
I waive the right to be shown information on this form which is to be used for graduate and
internship admissions purposes only.
Signature of Candidate (Optional)
Date
Reference: Please complete the questionnaire which begins on the following page:
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Candidate Name
Please complete the following questionnaire. Your responses will be assessed as part of the
admissions process by the Eastern Washington University Administrative Professional Educator
Advisory Board (PEAB). Any comments you can add at the end to assist that group in its decisionmaking process will be appreciated.
1.
What was your job title at the time you worked with this candidate?
2.
What was the candidate’s job title?
From year
to year
in the
(School District)
(School)
Where responses are indicated, please rate the candidate on the basis of the 1-4 scale as described.
Circle the appropriate number and comment as necessary.
Rating Scale:
1 = unacceptable
2 = acceptable with reservation
3 = acceptable
4 = outstanding
The following ratings represent my perspective on the leadership qualities specified:
1. desire to succeed
2. seeks opportunities to improve
3. respect among peers for his/her judgment
4. decision-making skills
5. problem analysis skills
6. going the “extra mile”, taking on extra assignments, exhibiting stamina
7. interpersonal relations with students
8. interpersonal relations with adults
9. generates/uses innovative ideas and strategies for professional practice
10. ability to deal with complex situations
11. ability to work collaboratively with students
12. ability to work collaboratively with adults
13. ability to deal with pressures of multiple tasks
14. oral communication skills
15. written communication skills
16. use of technology in the educational setting
17. ability to self-evaluate and grow from experiences
18. ability to receive criticism and responds to criticism constructively
19. understands the “big picture” regarding school issues
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Candidate Name
My overall perception of this applicant’s qualifications for admission to the Administrative
Internship:
1
Not Recommended
2
Recommended
with Reservation
3
Recommended
4
Highly Recommended
Please add your comments in the space below to explain your recommendation and assist in the
selection process or attach a separate letter of document. Leadership qualities should be included in
your comments. Your comments are very important in our decision for admission.
SIGNATURE
POSITION
DATE
PLEASE RETURN THIS FORM TO:
Dr. Lance Potter, Director of Educational Leadership
Eastern Washington University
Department of Education, 313B Williamson Hall
Cheney, WA 99004-2458 or email completed form to
rpotter6@ewu.edu or FAX to: 509-359-2899
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