TEXAS A&M UNIVERSITY-TEXARKANA
Teacher Preparation Program
(903) 223-3044

Graduate Initial Teacher Certification Intern Information Form

Please complete upon securing employment.

Contact Information
     
  Last Name:      
  First Name:      
  Last 4 digits of SSN:      
  Mailing Address:      
  City:      
  State:      
  Zip Code:      
  Home Phone Number:      
  Cell Phone Number:      
  Email Address - Home:      
  Email Address - District:      
  Teaching Area Subject:      
  Teaching Area Grade Level:      
     

Employing District Information
     
  Employing District:      
  Campus:      
  School Phone Number:      
  Superintendent Name:      
  Principal Name:      
     

Cooperating Teacher (Mentor) Information
     
  Mentor Teacher's    
Name:    
 
     
  Has Mentor Teacher    
completed the Cooperating    
Teacher Information Sheet?:    
 Yes   No 
     
  Has the Mentor Teacher    
made plans to attend    
Mandatory Fall Orientation?    
 Yes   No 
     

New Intern Checklist
     
  Have you done the following?

 
  Provided copy of ISD    
contract to Education Office?    
 Yes   No 
     
  Provided Statement of    
Eligibility completed by your    
ISD to Education Office?:    
 Yes   No 
     
  Enrolled in ED 585 Internship    
class?    
 Yes   No 
     
  Made plans to attend    
mandatory orientation    
 Yes   No 
     
  Applied for your    
Probationary Certificate    
 Yes   No 
     
  Started Fingerprinting Process      Yes   No 
     
 

State law requires that you be informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you. For more information see our Privacy Statement.