Jones International University®
Placement Request Form
Internships and student teaching are vital components of the JIU® programs leading to initial licensure. Most school districts prefer to work with the staff at colleges
and universities to place students. There are certain times throughout the traditional school year where districts honor requests for placements more than other times.
Guideline for requesting placements:
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For prime placements in the fall - requests to school districts begin in January
For prime placements in the spring - requests to schools districts begin in August
Begin thinking about where you want to complete your placement as you complete 15 credits. Refer to the K-12 Clinical Practice Guide, your Student
Solutions Advisor or the Clinical Practice Office for more information.
Please complete the following information for your placement requests. Then, save the document and e-mail it back to the Office of Clinical Placement at
ClinicalPractice@international.edu
Student Name:
Placement Request Date:
Student Number:
Placement State:
Degree Program:
Specialty Area (if applicable):
School District:
District Contact Name:
District Contact Email:
District Contact Phone:
Please select three schools within the district of your choice and provide the information below. Keep in mind, the district may not be able to place you in one of your
selections, but they do try.
1: School Name:
Principal:
2: School Name:
Principal:
3: School Name:
Principal:
School Phone:
Email:
School Phone:
Email:
School Phone:
Email:
Student Signature:
Jones International University®
9697 East Mineral Avenue Centennial, CO 80112
Date:
Proprietary and Confidential
Phone: 800.811.5663
10/2013
Fax: 303.784.8694