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School of Education

Reading Specialist Program Internship Application

*Deadlines: March 1 for Fall semester and October 1 for Spring semester

Personal & Professional Information

Name(Required)

First Middle Last

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Address(Required)

Street Address City State ZIP Code

Home Phone(Required)

Work or Mobile Phone(Required)

Regent Email Address(Required)

Education(Required)

Degree(s) Held

Areas

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Type of Teaching License Held(Required)

Professional

Provisional

None

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Date(Required)

MM slash DD slash YYYY

Virginia Endorsement(s) Held(Required)

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Current Teaching Position(Required)

Position

School

School District

State

Dates (From/To)

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Past Teaching Positions(Required)

Position

School

School District

State

Dates (From/To)

Please use the (+) to list all.

Internship Information

YOU MUST COMPLETE ALL COURSEWORK EXCEPT ETSP 596 AND EFND 598 PRIOR TO BEGINNING THE READING SPECIALIST INTERNSHIP.

Semester(Required)

Fall

Spring

Summer

Semester Year(Required)

What is your current GPA?(Required)

Your GPA must be above 3.0 for Internship Application to be approved.

Please enter a number greater than or equal to 3.0.

By the start of your internship, will you have completed all coursework except ETSP 596, EFND 598, & ETSP 501 (if required)?(Required)

Yes

No

Please explain.(Required)

Have you passed the Praxis Reading Specialist test #5302 (formerly RVE Reading Specialist Assessment)?(Required)

Yes

No

Test information, registration, and student material can be found at https://www.ets.org/.

Teacher Information

Are you a full-time teacher?(Required)

Yes

No

On-the-job?(Required)

Yes

No

What classes do you teach?(Required)

What is your current job?(Required)

Do you plan to take a leave of absence in order to do your internship?(Required)

Yes

No

Please explain how you plan to complete the required internship hours.(Required)

Professionalism & Christ-Like Survey Requirement

You are required to have one of your professors complete the Professionalism and Christ-Like Survey on your behalf. This should be a professor in your program with the exception of Dr. Maggi.

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Are you an employee or the spouse/dependent of an employee?(Required)

Employee

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Employee's First Name(Required)

Employee's Last Name(Required)

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Agent's Notes

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By entering my first and last name above and clicking “Learn More” below, this shall constitute my electronic signature and I expressly agree that Regent University may call or text me for marketing purposes at the number I provide above, including through the use of an automatic telephone dialing system and/or artificial or prerecorded voice or message according to the TCPA Terms & Conditions below. Accepting this consent is not required to obtain any good or service.

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