Gannon University Programs in Educational Leadership APPLICATION FOR PERMISSION TO REGISTER FOR A GRADU. Principal K-12 Certification Program TE INTERNSHIP iss the oficial application for requesting authorization to register fora Gannon University approved internship in the Education Ledership rogram. After the student receives a copy a his aplication showing the intership has boon approved, the STUDENT must pay all Unverity feos sand contact the Scheduling Office to camplet registration for tho interaship. Submission of this form will nt registra stadent for the intership [REGISTRATION MUST BE COMPLETED PRIOR TO THE. ‘SUB, ‘A description of the professional internship action plan that the applicant isto undertake must be attached before submitting this form for approval. L._Educational Data Name: “TO@1 NATAUE 2. ‘Student Identification Number: Last Pint Address During Internship: -Ba40 Tews Aye Srwssvest PA PSU City Stale Zip Home Address (I other than above) Sea oy Ta Home Phone: BO4)37R~BYOR —_ malt AddromytALA Es Jorki@ecspgh. ny Program Major:_Bincipl Catenion. __Antlpaed Program Complton Dte:.2.€)@ IL Internship Data ( ) Fall Semester (Spring Semester 9) Summer Semester CouseNember: OEDU728. Cone Seton Nuber_ Coe Te: Rel Moms Number of Cres 0. Propose te Soper Tte_1LO.N@ arya Pei, Tternsblp Site ENR Phone Number: HID 2H4Y=7TIO Address: M879 NASON EY OCR IRCA Ps. 1248 Internship Perio: ay YZ IT ends: 1 (ZA iA Number of Weeks: “7 Daily: fom B'3O pm 0B BO am ULL Internship Approval Candidate's Signature: Site Supervisor's Signatures, "The ste mentor bold prise ‘The site mentor has three years of experience W the role of principal Y CED Cease tear eto cee) ‘+ (it inup othe cand to eteine he inti ust alo Be apraved by the Hoard of esto) 19 Director’s Signature: Date: (Gannon Ualversy, Progra Fdnctoal Leads)