Single Subject PRE-APPROVAL Internship Eligibility Form

Single Subject PRE-APPROVAL Internship Eligibility Form

Intern Applicant Name:_________________________________Student ID:________________Subject Area:__________

This section is to be completed by the Academic Department Coordinator/Advisor

Intern applicant meets departmental requirements for internship eligibility: Yes No

Subject Matter Competency is met by: CSETs Subject Matter Prep Program/Coursework

Academic Department Coordinator/Advisor Name (print)____________________________________

Academic Department Coordinator/Advisor Signature_______________________________________

Today’s Date_________________________________

This section is to be completed by the Single Subject Credential Coordinator

Internship eligibility requires 9 units of coursework (120 hours).

The following courses/equivalencies meets this requirement.

Course / Equivalency Semester Completed

Credential Coordinator Signature ____________________________________________________________

This section is to be completed by the Intern Applicant

I certify that all information I have provided in this internship application is accurate
and I understand the requirements of the Teacher Internship Program.

Intern Applicant Signature __________________________________________ Date_______________

For Office Use Only

GPA 3.0 COC Constitution

Subject Matter: Coursework Exam

CBEST: R_________ M_________ W_________

Cred. Programs Admission Analyst Signature__________________________

Single Subject Teacher Internship Credential Program - Educational Plan

Intern Applicant Name:__________________________________Student ID:________________Subject Area:___________

Single Subject Teacher Internship Credential Program - Educational Plan
Completed Term/Year Course Course Name Units
EHD 50 OR Equivalent Pre-Program Field Experience 0-3
CI 149 Curriculum, Instruction, Technology 3
CI 151 Social Context of Teaching 3
CI 152 Educational Psychology 3
LEE 157 Teaching English learners in Sec. Classrooms 3
CI 161 (only offered at Fresno State) Methods & Materials in Sec. Teaching 3
EHD 155A
  • □ Initial Student Teaching
  • □ 1st Semester of Internship
  • □ Pre-disposition Survey
  • □ 6 observations & reflections
  • □ TPA: Site Visitation Project
  • □ Mentor Teacher Survey (ST only)
  • □ Supervisor/Coach Evaluation
 4
EHD 154A Initial Student Teaching/
1st Semester of Internship Seminar		 1
SPED 158 Diff. Instruction in Inclusive Settings 3
LEE 156 Content Area Literacy and Comm. in
Secondary Classrooms		 3
EHD 155B
Additional Information:
  • □ 2nd Semester of Internship
  • □ 1st, 2nd Semester of Internship (5, 5)
  • □ Post-disposition Survey
  • □ 6 observations & reflections
  • □ TPA: Teaching Sample Project
  • □ Supervisor/Coach Evaluation
 10
EHD 154B
Additional Information:		 2nd Semester of Internship Seminar 1
Once all program requirements are complete, you may apply for your preliminary credential:
http://fresnostate.edu/kremen/credential/singlesubject/completed-students.html		 34 -37
Additional Information/Comments:

Credential Coordinator Signature__________________________________________________________Date_____________

Intern Applicant Signature______________________________________________________________Date_______________

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