Senior Practicum Application

THE UNIVERSITY OF MISSISSIPPI
DEPARTMENT OF CURRICULUM AND INSTRUCTION
SENIOR PRACTICUM APPLICATION - SPRING

Student ID# (No SSN) :

First Name :

Middle Name :

Last Name :

DOB :

* mm/dd/yyyy

Major :

Address :

City :

State :

Zip :

Phone :

* xxx-xxx-xxxx

UM Email :

Confirm UM Email :

I am a University of Mississippi student on the campus of *

Select Placements in at Least 2 Different Districts
* Only listed schools below will be considered *

SCHOOLS: Elementary Schools List

1. What is your grade level preference?

2. Are you a teacher assistant? (minimum 3 years experience) *

Yes No

3. Select your content area(s) or areas of concentration *

1(Required). 2.

4. List Previous Placements: district, school ... and supervsing teacher

5. Give other information that is important to your placement

Please Press the "Submit" button only once

* Please note that all requests for placements are
considered, but no guarantees can be made.