ESOL Endorsement
Internship Request Form
Name: _______________________________________________ OSU Student ID #: _______________
MAT program: Multiple Subjects - Elementary
Language Arts
Requirements
ESOL or ESOL/Bilingual Endorsed Teacher
 Pre-service teachers: Your cooperating
teacher must hold a current ESOL or
ESOL/Bilingual endorsement.
 Practicing teachers: You must work with a
mentor at your site that holds a current
ESOL or ESOL/Bilingual endorsement (e.g.,
experienced ELL teacher, ELL Specialist, ELL
district coach, or ESD ELL coordinator)
Internship Placement Requirements
90 contact hours in an Oregon Classroom
teaching English Language Proficiency (ELP)
standards to a small group of ELLs at the
appropriate grade level.
Completed ESOL coursework
All coursework required prior to internship
except TCE 576, which can be taken final
summer term.
NES ESOL or ESOL/Bilingual Exam
Social Studies
Mathematics
Science
Office
Use*
Additional Information
Name of Cooperating Teacher or ELL
Specialist that holds an active ESOL or
ESOL/Bilingual endorsement from Oregon
TSPC.
Please print full name:
First
MI
Last
□ Cooperating Teacher
□ ELL Specialist
Location of Internship
School _____________________________
District _____________________________
Grade _______ # of ELL in class ________
□ TCE 219/419/522
□ TCE 572
□ TCE 576
□ TCE 573
□ TCE 579
Score report sent to OSU
Score ________
ESOL Authorization contract
Authorization signed off by:
Completed and signed contract submitted to
Work Sample Advisor with 1st Work Sample
□ Work Sample Advisor
□ Faculty Advisor
Submit this form to:
Jessie Buhrle
OSU-Cascades ESOL Coordinator
Graduate & Research Center
Office 116
541.322.3118
For office use only*:
Attach a copy of Cooperating Teacher or ELL Specialist TSOC teaching license.
□ Approved for TCE 510 Internship
□ Requested Course Override
□ Contacted Student
As of 10.10.13 JB