READING ENDORSEMENT INTERNSHIP It is the student s responsibility to submit the following forms and documents in one complete packet to Rio Salado College, Educator Preparation Office, 2323 W. 14 th Street, Tempe, Arizona 85281. All materials must be submitted as noted below. Any application packet that is incomplete will be returned and it will be the student s responsibility that all application materials listed on this check sheet are submitted. Indicate the grade level for which you are seeking an endorsement: READING ENDORSEMENT GRADES K THROUGH 8 READING ENDORSEMENT GRADES SIX THROUGH 12 READING ENDORSEMENT GRADES K THROUGH 12 1. Application for Admission: Submit a typed or printed completed form. Circle below which option you are pursuing for the Reading Endorsement: Option A: Completion of all Reading Endorsement coursework with Rio Salado College. Reading Endorsement Field Experience will require placement services from the Field Experience office at Rio Salado College. Skip item #2 - #3 below. Option B: Attach a letter from the school district Human Resources office OR school principal supporting the use of your classroom and school site for completion of all field experience hours. Letter must be on school/district letterhead. Application approval requires passing the of Arizona Educator Proficiency Exam Reading Endorsement K-8 or K-12. 2. Subject Knowledge (Option B Only): It can take up to six weeks to receive an official score report, please plan accordingly. Applications cannot be accepted without a passing score. Please check mark below which endorsement you will be pursing and which artifact you have provided. READING ENDORSEMENT GRADES K THROUGH 8 A passing score on the Reading Endorsement Subject Knowledge portion (46) of the Arizona Educator Proficiency Assessment (AEPA) for grades K through eight. READING ENDORSEMENT GRADES SIX THROUGH 12 A passing score on the Reading Endorsement Subject Knowledge portion (47) of the Arizona Educator Proficiency Assessment (AEPA) for grades six through 12. READING ENDORSEMENT GRADES K THROUGH 12 AND A passing score on the Reading Endorsement Subject Knowledge portion (46) of the Arizona Educator Proficiency Assessment (AEPA) for grades K through eight. A passing score on the Reading Endorsement Subject Knowledge portion (47) of the Arizona Educator Proficiency Assessment (AEPA) for grades six through 12. Reading Endorsement Application 2015-2016
3. Letters of Recommendation (Option B Only): Submit the confidential letter, in individually sealed envelopes. The forms are provided in your packet. 4. *Copy of a valid Arizona Elementary, Secondary, Special Education, Early Childhood teaching certificate. 5. Three years of full-time teaching experience. Please submit a Verification of Teaching Experience form from the District Superintendent or Personnel Director to verify teaching experience. 6. Fingerprinting: Submit a large photocopy (front and back) of the IVP fingerprint clearance card issued to you by the Department of Public Safety. The clearance card must be valid for the duration of your internship. 7. Biographical Information Sheet: Submit completed form. 8. FERPA: Submit signed original. 9. Date available to start Reading Internship: Please note: The Reading Endorsement requires 60 hours to be completed over an 8-week period. Fall 20 Spring 20 10. Name of School/District where you are requesting placement for the Reading Endorsement Internship: Option A: Must provide up to three school choices: School District: School: Address: School District: School: Address: School District: School: Address: Option B: School District: School: Address: Name of HR Director/Coordinator: Contact Information(email/phone): I verify that the application information I have submitted in this packet accurately represents my prerequisite coursework as required by the Rio Salado College Educator Preparation Program. Once accepted, the student understands that current tuition rates for 3 credit hours and a $15.00 registration fee will be assessed. NAME (Print) DATE Reading Endorsement Application 2015-2016
Application for Admission: Reading Endorsement Internship Please type or CLEARLY print entire application. Name (Last, First, Middle) Former Last Name(s) Address: (Number, Street, Apartment) (City, State, Zip) Telephone (include area code) E-mail Home: Cell: Certificates/Endorsements: Type of certificate Endorsements Issue Dates Expiration Date School Experience: Including pre-school, and K-12.(Do not include Rio Salado College Field Experience requirements) District Name/ City, State Assignment Grades/ Subject Dates of Employment Mo./Yr. to Mo./Yr. Full time (Yes/No) Reason for Leaving A.R.S. Section 13-3716 requires applicants to give notice of conviction of, admission of committing, or pending trial for any of the following offenses: sexual abuse of a minor, incest, first or second degree murder, sexual assault, exploitation of a minor, commercial sexual exploitation of a minor, aggravated or armed robbery, a dangerous crime against children as defined in A.R.S. Section 13-604.01, sexual conduct with a minor, molestation of a child, or exploitation of minors involving drug offenses. Have you been convicted of, admitted committing, or are you awaiting trial for any of the above- listed dangerous crimes against children? Yes No Have you been convicted of, admitted committing, or are you awaiting trial for a felony? Yes No Have you ever had a certificate revoked, suspended, denied or have you ever received a reprimand or other disciplinary action involving certification? No Yes (If yes, please give details on a separate sheet, signed, dated and notarized.)
BIOGRAPHICAL INFORMATION Name: Please let us know what you have been doing since you earned your initial teaching certification. Be as thorough as possible without being too expansive. Also, discuss why you want to obtain your Reading Endorsement. Tell us about any experiences you have had working with children and as a classroom teacher. Use additional pages if necessary. Please sign and date your biographical information. Signature: Date:
Option B ONLY Confidential Letter of Recommendation #1 Reading Endorsement Internship Student s Name Date: The above mentioned student is applying for a Reading Endorsement Internship. As part of the process, he/she has requested that you complete this letter of recommendation. Please keep in mind that we will be evaluating this individual s potential as a future Reading Specialist. Please indicate the strengths you believe the teacher candidate possesses that will help him/her become a Reading Specialist. Please indicate possible concerns you have about this student becoming a Reading Specialist:
On a scale from 0-5, (5=exceptional; 1=very poor; 0=don t know) please rate this individual in the following areas: 1. Verbal skills 2. Social adjustment 3. Dependability 4. Written communications skills 5. Oral communication skills 6. Overall ability Other comments or narrative: How long have you known this individual? In what capacity? Position or Title Agency Print Name Signature Date Place in a sealed envelope and mark it: CONFIDENTIAL Rio Salado Reading Endorsement Internship: Field Experience Office Recommendation Letter for Please return to prospective student who will include the envelope in their formal application packet.
FERPA Reading Endorsement Internship Release of Information Form Main Campus: 2323 W. 14th Street, Tempe AZ 85281 Phone: (480) 517-8126 Toll Free (800) 729-1197 Fax (480) 377-4713 STUDENT NAME: The Reading Endorsement Internship is a partnership between Rio Salado College, and participating school districts/charters. In order to ensure success of your internship, it is imperative that we share information about your coursework/progress with all partners. By completing this form you are granting permission for our office to discuss your status with other designees. I authorize Rio Salado College to share with any school district, charter school, sponsorship, or affiliated school and/or the Arizona State Department of Education information associated with my education record (ie. Completion of coursework) that will assist with completion of the Reading Endorsement Internship. Signature of Student Date Return form to: Educator Preparation: Field Experience Office 2323 W. 14th Street Tempe, AZ 85281 FAX: (480) 377-4713
Reading Endorsement Internship Participant Acknowledgement Form Student Name: Student ID #: As a participant in the Rio Salado College Educator Preparation Program, I understand eligibility for student teaching/internship placement and continued participation is dependent on the following: If I elect Option A, I must have all reading endorsement coursework completed with a 3.0 GPA or better 2- weeks prior to my Reading Endorsement Internship start date. If I elect Option B, I understand I must provide Rio Salado College with a passing Reading Endorsement Subject Knowledge score prior to a placement request being made with a school/district. If I elect Option B, I must attach a letter from the school district Human Resources office OR school principal supporting the use of my classroom and school site for completion of all field experience hours. Letter must be on school/district letterhead I understand: placement is 8-weeks in length. the Reading Endorsement Internship placement requires: Working Directly with Students in Reading (20 hours) Working Directly with Teachers in Reading (20 hours) (modeling how to work with struggling readers) Parent/Teacher Communication Regarding Reading (5 hours) Reading Professional Development Training for Teachers in Reading (10 hours) Activities Regarding Reading Endorsement Internship with site supervisor (5 hours) if I withdraw myself from my internship placement that I may receive a non-passing grade, may not be offered another opportunity to complete the internship. I will incur a $200.00 rescheduling fee per incident if I: 1) Cancel a confirmed placement 2) Refuse to accept a confirmed placement. that payment for my Reading Endorsement Internship course(s) is due 10 days prior to the course start date. that if I receive an email notification of charges from Rio Salado College, I will call Rio Cashier s at (480) 517-8334 and take responsibility for the balance on my student account or I will be dropped from my course. if applying for Financial Aid, it is my responsibility to verify with the Financial Aid office my eligibility of coverage for my internship course. I must regularly check my Maricopa email account for critical emails from the Field Experience Coordinator(s). if my contact information changes, it is my responsibility to update my contact information at my.maricopa.edu. Student Signature Date