Internship Request Form
Please complete this form if you are interested in completing a required internship (i.e., field work, student teaching, practicum) or student study in the Passaic Public Schools
Please review our
Passaic Public Schools Internship Protocol
Name
*
First Name
Last Name
Name
First Name
Last Name
Email Address
*
Confirmation Email
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Select Semester
*
Fall 2023
Spring 2024
Fall 2024
Which best describe your placement
*
Senior level field work
Student Teaching
Undergraduate practicum
SGMH Grant
Other
Select all that apply to your preferred placement
*
Art
Business
Career and Technical Education
Child Study Team - LDTC
Child Study Team - Psychologist
Child Study Team - Social Worker
Child Study Team - Speech Pathologist
ELL/Bilingual Teacher
Family and Consumer Science
Health
Language Arts/Literacy
LDTC - Preschool
Mathematics
Music
Naval Science
Physical Education
Psychologist - Pre School
Reading Interventionist
School Counselor
School Library Media Specialist
Science
Social Studies
Social Worker - Pre School
Social Worker - School based
Special Education Teacher
Teacher Grade 9-12
Teacher Grades 6-8
Teacher Grades K-5
Teacher Preschool
Theater Arts
World Language
Preferred Grade Level
*
PK
K
01
02
03
04
05
06
07-08
09-12
Self-Contained
Not Applicable
Do you have a preferred PPS school?
*
NO PREFERENCE, RECOMMEND IDEAL FIT FOR ME
01
03
05/5A
06
07
08/8A
09/9A
10/10A
11
15/15A
16
19
20
PHS
Science
Prep
School Status
*
Freshman
Sophomore
Junior
Senior
Graduate Student
What are your career goals?
*
What are the university expectations of the Passaic Public Schools as a district?
*
0/200
What are the university expectations of the cooperating teacher/team member?
*
0/200
Describe your experience (internship, employment or otherwise) with urban communities:
*
0/200
What are the university expectations of the host school?
*
0/200
Check all certifications you are CURRENTLY pursuing
*
Not Currently Certified
American Sign Language
Appliance Repair
Arabic
Art
Associate School Library Media Specialist
Bilingual Education
Biological Science
Blind or Visually Impaired
Chemistry
Chinese
Coop. Ed. Coordinator
Coop. Ed. Coordinator/Hazardous Occupations
Dance
Deaf or Hard of Hearing: Oral/Aural Communication
Deaf or Hard of Hearing: Sign Language Communication
Director of School Counseling Services
Driver Education
Earth Science
Educational Interpreter:-Cued Speech Transliteration
Educational Interpreter:-Oral Interpreting
Educational Interpreter:-Sign Language Interpreting
Elementary School Teacher in Grades K - 6
English
English as a Second Language
Fam & Con. Sci.
Fam & Con. Sci.: Apparel, Textiles, and Interiors
Fam & Con. Sci.: Child and Family Development
Fam & Con. Sci.: Foods/Nutrition and Food Science
French
German
Grades 5-8: Language Arts/Literacy Specialization
Grades 5-8: Mathematics
Grades 5-8: Science
Grades 5-8: Social Studies
Grades 5-8: World Language/American Sign Language
Grades 5-8: World Language/Arabic
Grades 5-8: World Language/Chinese
Grades 5-8: World Language/French
Grades 5-8: World Language/German
Grades 5-8: World Language/Greek
Grades 5-8: World Language/Hebrew
Grades 5-8: World Language/Italian
Grades 5-8: World Language/Japanese
Grades 5-8: World Language/Korean
Grades 5-8: World Language/Latin
Grades 5-8: World Language/Other World Languages
Grades 5-8: World Language/Polish
Grades 5-8: World Language/Portuguese
Grades 5-8: World Language/Russian
Grades 5-8: World Language/Spanish
Greek
Health and Physical Education
Health Education
Hebrew
Italian
Japanese
Korean
Latin
Learning Disabilities Teacher-Consultant
Mathematics
Military Science
Music
Other Foreign Languages
Physical Education
Physical Science
Physics
Portuguese
Preschool through Grade 3
Principal
Psychology
Reading
Reading Specialist
Russian
School Administrator
School Athletic Trainer
School Business Administrator
School Counselor
School Library Media Specialist
School Nurse
School Nurse/Non-Instructional
School Occupational Therapist
School Physical Therapist
School Psychologist
School Social Worker
Social Studies
Spanish
Speech Arts and Dramatics
Speech Language Specialist Equivalency
Speech-Language Specialist
Student Assistance Coordinator
Students with Disabilities
Supervisor
Swimming and Water Safety Instructor
Teacher of Agriculture
Teacher of Supplemental Instruction in Reading and Mathematics, Grades K-8
Teacher of the Handicapped
Technology Education
Theater
Other
Select College/University
*
Caldwell
FDU
Felician
Kean
MSU
NJCU
NJExcel
NJIT
PCCC
Ramapo
RELAY
Rowan
Rutgers
Seton Hall
Stockton
TCNJ
WPU
Other
College/University Contact Person
*
First Name
Last Name
College/University Contact Person Email
*
example@example.com
College/University Contact Person Phone Number
*
-
Area Code
Phone Number
Upload your fingerprinting/background check information
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Upload your substitute teacher certificate information
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Please share the details of the course that requires this internship
*
Upload any forms and documentation from your school relevant to this request
*
Upload a File
(Memorandum of agreement, placement forms, etc.) Acceptable File Types: PDF, Microsoft Word Document (.doc, .docx)
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Click below to upload your resume
*
Acceptable File Types: PDF, Microsoft Word Document (.doc, .docx).
Please review our
Passaic Public Schools Internship Protocol
Signature - I have reviewed & understand the Passaic Public Schools Internship Protocol
*
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Has this potential intern completed the fingerprinting process?
Yes
No
Has this potential intern completed the background check process?
Yes
No
HR Submit
Division of Staff Development Use Only
DSD Administrator Password
Application is
Approved
Rejected
Reason for Rejection
PPS intern placement school
*
01
03
05/5A
06
07
08/8A
09/9A
10/10A
11
15/15A
16
19
20
PHS
Science
Prep
Cooperating Team Member
Cooperating Team Member Email
example@example.com
Cooperating Team Member Supervisor/Principal Email
example@example.com
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upload documents that need to be returned to requestor
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