The University of Akron
College of Education
Educational Foundations and Leadership
Akron, OH 44325-4208
Phone: 330-972-7773 Fax: 330-972-2452
Application for Administrative Internship
To the applicant: Only completed applications are accepted. Respond to all items in this application form. Do not refer the reader
to other documents for the requested information. Data submitted in and with this application are expected to be complete and
accurate.
Date
ID No.
Email Address
Name
Last
First
Middle
Last
First
Middle
Previously Used Name
Present Address
Street
City
State
Zip
City
State
Zip
Present Phone
(Area Code) Number
Home Address
(if different from present
address)
Street
Other Phone
(Area Code) Number
Date application submitted
Date application received
Licensure Internship for which you are applying
Principal, Ages 5-12 (K-6)
Principal Ages 8-14 (4-9)
Principal, Ages 10-21 (5-12)
Superintendent
Education
If you have not graduated, list degree sought and anticipated graduation date.
Master’s Degree
Date Granted
Granting School
If Doctorate degree has been granted,
list date and granting school
Date Granted
Granting School
The coursework required for this administrative license, other than
the internship, was/will be completed
Application for Administrative Internship
Completion Date
Page 1
Current Educational Employment
Dates
Employer & Location
Your Titles & Duties
Status
(Month/Year to Month/Year)
Certification Issued by the State of Ohio
Areas listed on the Certificate/License
Type of Certificate/License
Expiration Date
Permanent
Eight-Year Professional Certificate
Five-Year Professional License
Permanent
Eight-Year Professional Certificate
Five-Year Professional License
Permanent
Eight-Year Professional Certificate
Five-Year Professional License
Permanent
Eight-Year Professional Certificate
Five-Year Professional License
Preference for Cooperating Field Administrator (CFA)
Name
CFA’s Title
Phone
CFA’s Email
School/District
CFA’s Address
City/State/Zip
Fax
Note 1: Applicants are considered without regard to their race, color, religion, sex, national origin, age, or disability status.
The undersigned certifies that all statements on this application and the pages attached to it are true and complete.
Note 2: The Ohio Assessments for Educators (OAE) exam must be taken either prior to or during the course of the internship.
Passage of the OAE is required before receiving a final grade (Spring semester) for the Internship.
I understand that false or incomplete statements may result in disqualification or dismissal from the Internship.
Signature of Applicant
Application for Administrative Internship
Date
2
Advisor Notes (Applicants, do not write in this area)
Date
Remarks
Advisor has verified Master’s degree or higher, which includes all coursework required of the Master’s degree as of the
date of application.
Advisor has verified completion of coursework other than the Internship.
Advisor recommends applicant for Internship
Advisor’s Signature
Date
Approved for Internship:
Department Chair Signature
Application for Administrative Internship
Date
3