Education Internship Application

INTERNSHIP APPLICATION
USCA School of Education • 471 University Parkway
Aiken, SC 29801
(803) 641-3483

APPLICATION INFORMATION

		Application Date :
Last Name:	First Name:	Middle Initial:
Candidate ID # ( last 4 digits of your SSN):
Current Mailing Address:
City:	State: ZIP:	Phone:
Current Email Address:
Summer Mailing Address (if different):
City:	State: ZIP:	Phone:
Email Address:
The following information is required for statistical reporting only. It is not used to identify any candidate and it does not affect the candidate’s application.
Birthdate:	Gender:	Ethnicity:
Intern Semester: Fall Spring Year
Assignment Preferences:
Grade Level Preferences: Early Childhood Education Major: Elementary Education Major: Secondary Education Major: Special Education Major

What schools have you attended?: List the schools you have attended.
Do you have any family members working / or attending schools in your preferred district? Yes No If Yes, list the family member and the school(s) they work/attend.
By checking this box I acknowledge this as my electronic signature and as such certifies that all of the information contained in this application is factually correct, is honestly presented, and contains no significant omissions. If, at a later date, it becomes clear that this is not true, I agree that the University may revoke any offer of admission it makes to me or to dismiss me from the University.