Graduate Studies in Education

JORDAN SCHOOL DISTRICT

Human Resource Department

Administrative Internship Request Form

Please Print:

Name:________________________________________________________________________________

Address:______________________________________________________________________________

Current Position: _______________________________________________________________________

Current Contract:                Traditional   /   Year-round:   _______ track  (Please circle one)

Current School Location: _____________________________________

Administrative Certification Program: __________________________          

Name of Intern Advisor: ______________________________________

Administrative Internship Schedule:

All administrative internship hours must be pre-approved by June LeMaster, Executive Director of Human Resources and completed” off contract time or outside your regular school assignment,” if you are a current employee of Jordan School District.  This does not include LPP Interns or those interns placed by and receiving pay through the district.

Please circle the months below when you are available to complete your internship hours.

Elementary:            Aug.          Sept.,          Oct.,     Nov.,     Dec.,     Jan.,     Feb.,     Mar.,     Apr.,     May,    June

Secondary:             Aug.           Sept.,      Oct.,     Nov.,     Dec.,     Jan.,     Feb.,     Mar.,     Apr.,     May,    June

Special Ed:              Aug.           Sept.,      Oct.,     Nov.,     Dec.,     Jan.,     Feb.,     Mar.,     Apr.,     May,    June

Administrative Internship Placement Preferences:

Elementary K-12 Feeder Systems:                                                         Secondary K-12 Feeder Systems:

___           Alta                            ___           Hillcrest                                      ___           Alta                            ___   Hillcrest

___           Brighton                    ___           Jordan                                        ___           Brighton                  ___    Jordan

___           Bingham                 ___           Riverton                                       ___           Bingham                 ___   Riverton

___           Copper Hills            ___           West Jordan                              ___           Copper Hills            ___   West Jordan

My signature below indicates that I understand my administrative internship hours must be pre-approved by June LeMaster, Executive Director of Human Resources and I further agree to all administrative internship procedures and conditions of this internship.

 
_______________________________________                                  ________________________                           

Signature of Administrative Intern                                                                                       Date

 
_____________________________________                                    ________________________

Signature of University Intern Advisor                                                                              Date

Please return this form to the Human Resource Department
Attention:  June LeMaster, Executive Director