Assessment
TABLE OF CONTENTS
Table
of Contents.................................................................................................................... 1
Instructions
for Processing License Application and Requesting Transcript
........ 2
Information
Required to Process License Application............................................................... 3
Application
For Teaching License
.................... 4
Request
For Official Arkansas Tech Transcript......................................................................... 5
School
of Education Follow-up Participation Form................................................................... 7
School
of Education Postgraduate Projection Form.................................................................. 8
Instructions
for Advising Questionnaire..................................................................................... 9
Instructions
for Evaluation of the Internship Experience............................................................. 13
Internship
Experience Evaluation.............................................................................................. 14
Exit
Competency Part I............................................................................................................ 17
Exit
Competency Part II.......................................................................................................... 20
INTERNSHIP
EXIT BOOKLET
Please read the
following instructions carefully!!
Do not write or Mark in
this Exit Booklet
1.
INFORMATION REQUIRED TO PROCESS LICENSE APPLICATION - Complete the form behind
the sample page and leave it in the exit booklet. (p. 3)
2.
APPLICATION FOR TEACHING LICENSE - Complete the form
behind the sample page according to the verbal instruction given. It
will be collected by your facilitator. Just a reminder - this
form needs to be PRINTED and filled out in INK. (p. 4)
3. REQUEST FOR OFFICIAL TRANSCRIPT Complete
the form behind the sample page according to the verbal instruction given
. It will be collected by your
facilitator. (p. 5)
INFORMATION REQUIRED TO
PROCESS LICENSE APPLICATION
(Please leave this form
in your exit booklet)
Name:
__________________________________________________ SSN:
____________________
(Last, First, Middle, Maiden)
Date of program
completion: __________________
If you are not
completing the program this semester, when do you plan to complete it? ___________
Do you intend to apply
for an Arkansas Teaching License? Yes
_____ No ______
Licensure Areas:
_____________________________
_____________________________
_____________________________, be sure to list all areas.
Are all Praxis II,
Subject Assessments/Specialty Area Test scores on file with Dr. Morgan,
Director Teacher Education Student Services Office, Crabaugh 109? Yes _____ No ______
If no, indicate the date
you plan to take the necessary test(s) __________________________
If
yes, indicate date taken. _______________
If no, indicate the date
you plan to take the test. ________________
I understand that a
completed application and appropriate PRAXIS SCORES which meet or exceed the
score as determined by the Arkansas Department of Education accompanied by
official transcripts from all
institutions
attended must be filed with the Certification Officer, Dr. David Bell, CRA 204,
before processing can begin. Dr. Morgan
will forward all necessary copies of PRAXIS scores to Dr. Bell.
I give permission to
Arkansas Tech University to release my PRAXIS scores to the Arkansas Department
of Education and to use my PRAXIS scores in any study that is required by the
School of Education. I also understand
that confidentiality will be maintained in any study in which the scores are
used.
Signed:
_______________________________________
Date:
_________________________________________
SAMPLE - APPLICATION FOR
TEACHING LICENSE
(Please leave this form
in your exit booklet)
Leave this form with
your facilitator.
INSTRUCTIONS
FOR FOLLOW UP PARTICIPATION AND POSTGRADUATE PROJECTION FORMS
Please read the
following instructions carefully!!
Do not write or mark in this Exit Booklet
1. FOLLOW-UP PARTICIPATION FORM -
Complete the form behind the sample page and leave it in the exit booklet. (p. 7)
2. POST GRADUATE PROJECTION FORM -
Complete the form behind the sample page and leave it in the exit booklet. (p. 8)
SCHOOL OF EDUCATION
Follow-up Participation
Form
(Please leave this form
in the exit booklet)
I agree to
participate in a follow-up study for the School of Education at Arkansas Tech
University. I grant permission for
future supervisors to provide information to the School of Education with the
understanding that such information will be confidential. Leave this form in the exit booklet.
________________________________ ______________________________
(Name)
(Please Print) (Signature)
________________________________
(Date)
SCHOOL OF EDUCATION
(Please leave this form
in the exit booklet)
Date: _______________
Name of Student:
______________________________________________________ Sex _____
(Last, First, Middle, Maiden)
Mailing Address after
graduation: __________________________________________________
____________________________________________
__________________________________________________
Date of Graduation:
__________Teaching Field(s): ____________________________________
What type of position or
activity do you expect after graduation?
_____________________________________________________________________________
Do you plan to attend
graduate school? ________ Where? ______________________________
Have you found
employment in the teaching field for the coming school year? ______________
If so, where?
__________________________________________________________________
Subject or grade to be
taught: _____________________________________________________
Phone number(s) after
graduation: _________________________________________________
IMPORTANT: Please notify the School of Education
immediately of any changes in the above information if there are any within the
next year. This is important to our
follow-up study of graduates.
INTERNSHIP EXIT BOOKLET
Please read the
following instructions carefully!!
Do not write or mark in
this Exit Booklet
All of the
questionnaires in this section of the exit booklet are to be answered on a
Scantron Form inserted behind the designated page number. Scantron Forms must be marked using
a # 2 pencil. Each of these
questionnaires is to be answered anonymously, please do not include any
identifying information on the Scantron Form. Leave the Scantron Forms in the
exit booklet.
SCHOOL OF EDUCATION
STUDENT ADVISING QUESTIONNAIRE - The last page of this questionnaire (PART 2.
page 12) requires a written response from you.
Please write your answers in the white space to the left of the numbered
section on the Scantron Form (you may use both sides if needed). Be sure to number your answer to correspond
with the number of the question on the questionnaire. (p. 10-12)
SCHOOL OF EDUCATION
Student Advising
Questionnaire
(Please use the Scantron
Form inserted behind this page)
PART 1.
1. My gender is
1. Male
2. Female
2. My age is
1. 17 - 22
2. 23 - 34
3. 35 - 50
4. over 50
3. My cumulative G.P.A. is approximately
1. below a
2.5
2. 2.5 -
2.99
3. 3.0 - 3.5
4. above 3.5
4. I have attended ATU for