BALTIMORE COUNTY PUBLIC SCHOOLS



BALTIMORE COUNTY PUBLIC SCHOOLSINTERNSHIP APPLICATIONDate of Application: Click here to enter text.Institution of Higher Education (IHE) ContactIHE: Click here to enter text.Name: Click here to enter text.Title: Click here to enter text.E-Mail: Click here to enter text.Directions: Complete all information ELECTRONICALLY.Part I: To be completed by applicant.E-mail the completed file as an attachment to the IHE contact listed above.Part I: To be completed by applicant.E-mail the completed file as an attachment to the IHE contact listed above.First Name: Click here to enter text.Last Name: Click here to enter text.Birth Date: Click here to enter text.Email Address: Click here to enter text.Permanent Home AddressStreetClick here to enter text.City Click here to enter text.StateClick here to enter text. Zip Click here to enter text.PhoneClick here to enter text.Cell Click here to enter text.Address During InternshipSame as permanent address ? OR StreetClick here to enter text.CityClick here to enter text. StateClick here to enter text.Zip Click here to enter text. PhoneClick here to enter text.Cell Click here to enter text.High School Attended: Click here to enter text.City/State: Click here to enter text.Relatives in BCPS:Name(s): Click here to enter text.Relationship(s): Click here to enter text.School(s): Click here to enter text.Internship Semester:Internship Year: Click here to enter text.BCPS Employee? Yes ? No ?Internship Hours/Days*: Click here to enter text.Level Preference (ES, MS, HS or Special School): Click here to enter text.School Setting Preference (Inclusion or Self-Contained or “None” if not a special educator):College Major: Click here to enter text.Click here to enter text.Transportation Available: Click here to enter text.If car pool, with whom? Click here to enter text.Employment During Internship (Indicate “none” if intern will not be employed during internship):Location (Indicate N/A if not employed during internship): Click here to enter text.Hours (Indicate N/A if not employed during internship): Click here to enter text.Full-time internships may not be completed concurrently with paid employment for BCPS.Additional information you wish to provide: Click here to enter text.Part II: To be completed by plete information on top of front page.E-mail the completed file as an attachment to internships@Part II: To be completed by plete information on top of front page.E-mail the completed file as an attachment to internships@Additional information about applicant to aid in placement. Click here to enter text.Remuneration$Click here to enter text.Beginning DateObservation (Phase 1): Click here to enter text.Full-time (Phase 2): Click here to enter pletion DateObservation: Click here to enter text.Full-time: Click here to enter text.IHE Supervisor: Click here to enter text.Director’s Name:Click here to enter text.Part III: To be completed by Baltimore County Public Schools.E-mail approved application file to the principal, preservice mentor, IHE contact, and applicant.Part III: To be completed by Baltimore County Public Schools.E-mail approved application file to the principal, preservice mentor, IHE contact, and applicant.Name of Assigned School or CenterAssigned School Information:Grade Level: Click here to enter text.Subject Area: Click here to enter text.Preservice Mentor: Click here to enter text.Principal: Click here to enter text.E-mail: Click here to enter text.E-mail: Click here to enter text.Date Approved:Click here to enter text.Deborah PiperCoordinator, Teacher DevelopmentBaltimore County Public SchoolsOffice of Organizational Development105 W. Chesapeake Avenue, Towson, MD 21204Phone: 443-809-0363Fax: 410-296-3025Comments:Please call the preservice mentor prior to your plete BCPS volunteer training and obtain a BCPS fingerprint card prior to the first day of the internship and present the card at building sign-in.If you will be late or absent, call the school office in the morning.Other Click here to enter text.Only applications submitted by colleges and universities with placement agreements with Baltimore County Public Schools will be processed. Interns are NOT to submit their own applications. ................
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