Zone 6 Ed 2500, PS I, PS II Student Teacher Request

FOIP Statement

FOIP Markup

Protection of Privacy - The personal information requested on this form is collected under the authority of
Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act (“Act”) and will be protected
under Part 2 of the Act. The information is collected for the purpose of identifying practicum and internship
placements for students. If you have any inquiries in regards to the collection of your personal information,
please direct those inquiries to: FOIP Coordinator, ��Ѹ��Դ��߿�Ƭ of Lethbridge, 4401 ��Ѹ��Դ��߿�Ƭ Dr. West,
Lethbridge, Alberta T1K 3M4, telephone: 403-332-4620, email: foip@uleth.ca.

Section 1: General Teacher Information

Salutation:

Given:

Surname:

Former Surname:

E-mail:

School Name:

School City:

Permanent Certificate:

Yes

Years of teaching experience:

Please indicate below the Grade level(s) and Subject(s) you will be teaching in the coming year:

Fall Grade(s)/Subjects (Sep. - Dec.):

Spring Grade(s)/Subjects (Jan. - Jun.):

What will your 2024-2025 teaching assignment be?:

Full-Time

1/2-Time

Have you mentored a U of L Student Teacher/Intern before?:

Yes

Section 2: Placement Information

Please indicate the level(s) of practicum student you are interested in. If you have more than one preference, specify preference by number order (i.e. 1,2). We cannot guarantee preferences or placements, however we will do our best to accommodate your request. Requests will be kept on file for the 2024/2025 school year:

Questions	1	2	3
Education 2500: Grades K - 6, Fall (Sep. - Dec.)	1	2	3
Professional Semester I (PS I): usually Grades 1 – 6, five-week practicum offered once yearly (November to December)	1	2	3
Professional Semester II (PS II): usually Grades 7 – 12, but sometimes Elementary grades, six-week practicum offered once yearly (March to April)	1	2	3

Agree

I have made my school administrator aware of my interest in mentoring a U of L student teacher for the 2024/2025 school year, and understand that my school administrator will be contacted to discuss specific placements in a school prior to each respective practicum semester.

Submitted requests do not guarantee that a student will be placed with a teacher, but rather are an indication of interest and support. The information you provide will facilitate the assignment of practicum students in the coming school year.

Interested in mentoring note

For teachers interested in mentoring a PS III student intern, please email edu.fieldexp@uleth.ca and we will forward the DocuSign form to complete.

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Faculty of Education

2025/2026 Faculty of Education - Field Experiences

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