INTERNATIONAL PRACTICUM PROGRAM TEACHER CANDIDATE APPLICATION

							                                                                                              International Practicum Application (2012-2013) Page 1 of 2




            INTERNATIONAL PRACTICUM PROGRAM TEACHER CANDIDATE APPLICATION
Application Deadline:                    Wednesday, November 21, 2012

Teacher Candidates in the Faculty of Education are eligible to apply for the 2012-2013 three month practicum program in
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Thailand at Lertlah School.

Please read the form carefully and then provide the requested information by typing it into the electronic document. When
completed, print off the entire application, sign, and date. Keep a copy for your records. The completed application can be
submitted to the contact information on page 2.

                                                         DECLARATION OF INTEREST

    Submitting and signing this application is a declaration of your interest in participating in an International Practicum
    Program. However, it does not designate any obligations for applicants at this stage. You will be asked to participate in
    an in-person interview in December, 2012.

                                                          APPLICANT INFORMATION

    Last Name:                                          Given Names:

    Student No.                                         Home Phone:                                      Cell Phone:
    Year in Program:                                    Stream:                                          Cohort:
    Street Address:                                                                                      Unit No.:
    Community:                                                                       Postal Code:
    Please note official communication with applicants will be done using U of M emails.
    University of Manitoba Email Address:
                                                                   REFERENCES

    You are asked to submit two hardcopy reference letters that speak to your suitability for this program. These can be (a)
    submitted with the application, (b) mailed separately to the address listed on page 2, or (c) faxed to 204.474.7551
    (attention: “Tara Baxter”). Please list the contact information below for the two references in the event we need to reach
    them.

    Reference No. 1

    Full Name:                                                                       Relationship:

    Address:                                                                         Phone:

    Email Address:

    Reference No. 2

    Full Name:                                                                       Relationship:

    Address:                                                                         Phone:

    Email Address:


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  Priority will be given to Year 1 teacher candidates. Students in Year 2 may apply, but if selected, will have to register with Extended Education as the
course offering falls after the graduation date. There are some Year 1 Senior Years teacher candidates who may be able to use the 3 credit hours as an
elective in the Summer Session, but for the majority of Year 1 students, this course cannot be used as part of the B.Ed. Program. However, if
successfully completed 3 credits may be used towards a Post-Baccalaureate Diploma in Education (PBDE) within nine years.
                                                                         International Practicum Application (2012-2013) Page 2 of 2

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to my acceptance in any of the International Practicum Programs offered by the Faculty of
Education at the University of Manitoba, I understand that false or misleading information in my application or interview
may result in my release from the applicable International Practicum Program.


Signature                                                                            Date


  When completed, print off the entire application, sign, and date. Any questions can be directed via email to
  assocdeanug_educ@umanitoba.ca or by phone to 204.474.9015. Please submit the completed hard copy application
  to the Associate Dean’s Office (Room 213, Education Building) or by mail to:

  Dr. David Mandzuk, Associate Dean (Undergraduate Programs)
  Faculty of Education, University of Manitoba
  Room 213, Education Building
  Winnipeg MB R3T 2N2

  WRITTEN COMPONENT OF APPLICATION

  Please answer the following questions as part of your application. Your answers are to be typed into the text boxes
  below on the electronic document. Please do not exceed 250 words per answer.

Reasons for wanting to visit and teach internationally:




What you hope to gain from travelling and teaching internationally:




Which EAL or cross-cultural education course(s) have you taken or plan to take to prepare you for teaching
internationally? Additionally, you can list any applicable experience you may have (e.g., volunteer work,
related non-education courses, or programs completed):