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* 1. Last Name

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* 2. First Name

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* 3. Address (Please put the address where you will be living if chosen for the internship)

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* 4. Phone Number

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* 5. Email Address (Where you can be reached daily)

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* 6. What college or university do you currently attend?

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* 7. I am currently a ....

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* 8. What is your anticipated graduation date?

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* 9. Are you interested in teaching in a Title I school?

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* 10. Please rank in order your preference for which level you are most interested in teaching.

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* 11. Why have you chosen the field of education as your career?

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* 12. Briefly explain your reasons for applying to the GCPS Special Education Internship Program. Please include specific objectives and expected benefits of the internship.

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* 13. Where do you see yourself in five years?  Include your long-term and short-term goals.

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* 14. Briefly describe your experiences with students with disabilities.

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* 15. Select the 2 special education programs you are most interested in teaching.  Please share why.

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* 16. Please share any additional information about you and/or experiences you would like the Internship Review Team to consider.

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* 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.

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