EDUCATIONAL ADMINISTRATION INTERNSHIP PLACEMENT REQUEST Program:

Semester:

Name:

Year: ID #:

Email:

Phone:

Cell:

License for which the field experience is requested and grade level experience: Ø   Ø   Ø   Ø  

Principal. Preference level for 280 hours: ______________________ (secondary or elementary) Principal. Necessary 40 hours at level: _____________________ (secondary or elementary) Superintendent. 320 hours Superintendent. 20 hours in non normal public U.S. school district/entity

Program Placement: 1.   Secure liability insurance: You must have liability insurance. You can obtain the insurance with a credit card from the following website: www.educationminnesota.org 2.   Background Check: Please go to the following website for frequently asked questions regarding background checks. http://www.d.umn.edu/educ/programs/field_experience/index.html . To have a check done go to http://www.duluth.umn.edu/umdhr/Policies/hiring/background.htm and complete the Personal Disclosure Statement and Background Check Consent form. a.   Forms can be sent to Rhonda Lemon, Executive Office & Administrative Specialist, ATTN: Background Checks, 123 Bohannon Hall, 1207 Ordean Court, Duluth, MN 55812 Location Selection: 1.   Where are you currently working? 2.   Who is your direct supervisor? 3.   Is this someone you would consider for your on-site supervisor? 4.   Does this individual hold a current Minnesota license appropriate for the level and position currently held? (Check on the MN Department of Education website for accuracy.) 5.   Of the 320 hours for the principal’s licensure, 40 need to be at a site not normally addressed by the candidate in the course of work. Who do you know that would be a successful on-site mentor for you and where is that site? (who) and (where) 6.   Does this individual hold a current Minnesota license appropriate for the level and position currently held? (Check on the MN Dept of Ed website.) 7.   For the superintendent license, you need 320 hours of internship experience at the district level. Who might you work with in your area? Provide 2 possibilities: Do these individuals hold a current Minnesota superintendent license? 8.   Where might you decide to go for the 20 hours of not U.S. public school experience? Return: Charles Rick, EduE 150, Duluth, MN 55812 or fax: 218-726-7008