Practicum Site Cert. & Website Request

PRACTICUM SITE CERTIFICATION & WEBSITE REQUEST

Date

Legal Name of Host School (type name as it should appear on certificate)

Address

Phone

School Director

Name of MIA-Certified Teacher Education Program (TEP) approving these site(s)

Course Levels Represented at School (list program director's name and course level followed by a semi-colon. exp. Julia Pane EC 3-6; Normi Son Elem 6-12)

As dirctor of this host school, I affirm that the classroom(s) listed belower were approved by:

Teacher Edudcation (Provide name of TEP below)

MIA-Approved On-Site Reviewer (Provide name of reviewer below)

Practicum Site Classrooms - Identify all by age level and room designation (Separate each by a semi-colon. Exp. B-3/Room B; 3-6/Room 4)

Upload Supporting Document

Upload supported file (Max 15MB)

I agree to theHost School Terms & Conditions

Thanks for your order!

The form on this page is for an online application and payment for MIA certificate and MIA website presence of Practicum Site(s) by a Host School.

If you would prefer to download a PDF version of the application to complete and save on your computer or to fill in by hand, download the file below.

A Practicum Site is defined as an operating classroom, with regularly enrolled children, which is qualified to allow an Adult Learner to perform their practicum. A Host School is the school where the Practicum Site is located.

A Practicum site is usually affiliated with a Teacher Education Program (TEP). A representative from the Teacher Education Program, or an MIA ON-Site Reviewer, evaluates and verifies that the Practicum Site meets the qualifications as defined in the MIA Certification Standards and Procedures.

Practicum Site certification is for a period of 1 year from date of certification.