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Student Teacher/Intern Assignment Verification

About this Form

Form number: 440-12

Audience:  Student Teachers

Last revised: May 2019


1. Student teaching is considered the final field experience before entering the teaching profession. This form is to be completed for student teaching only. This form is not for observation or practicum experiences.
2. Please complete one form for each assignment.
3. Requests for student teacher internships must be received by June 1 for Fall semester internship, October 1 for Spring semester internship, and April 1 for Summer semester internship.
4. This form and all associated documents including the fingerprint background review, Child Protective Services (CPS) review, and annual districtwide compliance training requirements, must be received prior to the start date of the internship.
5. The Higher Education Representative should scan and e-mail the completed and signed form to

6. Higher Education representative will be notified of approval/denial of the internship assignment. Assignments cannot begin before the verification of the required fingerprint background review, CPS review, and annual districtwide compliance training requirements.

Adobe PDF Student Teacher/Intern Assignment Verification462 KEnglish

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