Special Education Internship Application 2022-23 Question Title * 1. Last Name OK Question Title * 2. First Name OK Question Title * 3. Address (Please put the address where you will be living if chosen for the internship) OK Question Title * 4. Phone Number OK Question Title * 5. Email Address (Where you can be reached daily) OK Question Title * 6. What college or university do you currently attend? Brenau University Clark Atlanta University Florida State University Georgia Gwinnett College Georgia Southern University (Armstrong, Liberty, Statesboro Campuses) Georgia State University Kennesaw State University Liberty University Mercer University Piedmont College University of Central Florida University of Georgia University of North Georgia University of Phoenix Valdosta State University Walden University Other (please specify) OK Question Title * 7. I am currently a .... College Senior College Junior Other (please specify) OK Question Title * 8. What is your anticipated graduation date? November 2022 December 2022 May 2023 I have already graduated and I have at least a Bachelor's Degree Other (please specify) OK Question Title * 9. Are you interested in teaching in a Title I school? Yes No OK Question Title * 10. Please rank in order your preference for which level you are most interested in teaching. 1 2 3 4 Elementary 1 2 3 4 Middle 1 2 3 4 High 1 2 3 4 No preference OK Question Title * 11. Why have you chosen the field of education as your career? OK Question Title * 12. Briefly explain your reasons for applying to the GCPS Special Education Internship Program. Please include specific objectives and expected benefits of the internship. OK Question Title * 13. Where do you see yourself in five years? Include your long-term and short-term goals. OK Question Title * 14. Briefly describe your experiences with students with disabilities. OK Question Title * 15. Select the 2 special education programs you are most interested in teaching. Please share why. Autism (ASD- I, Severe) Autism (ASD-II, Moderate) Autism (ASD-III, Mild) Emotional Behavior Disorder (EBD) Interrelated (Resource and/or Co-teaching) Moderate Intellectual Disabilities (MOID) Severe and Profound Intellectual Disabilities (SID/PID) Visual Impairments Why? OK Question Title * 16. Please share any additional information about you and/or experiences you would like the Internship Review Team to consider. OK Question Title * 17. Please provide the name and contact information for a current supervisor or supervising professor that can be used as a recommendation for your participation in this program. Name Company/School Email Address Phone Number OK DONE