ࡱ> bea  bjbj Aax_x_ f f    8DTL Q(N(   """'''''''$*U-'""""'   ("d  `&p"'4""KyFL"L&!(0Q(T",..""8.""""""""''8"""Q(""""."""""""""f X :  Tuition Waiver Request for Pre-Interns This form allows collaborating teachers to request a tuition waiver after hosting a pre-intern. A pre-intern is defined as a student in USFs College of Education engaged in required early field experience prior to their final internship. Collaborating teachers should document hours of supervision. Hours may be accumulated across multiple semesters; however, a minimum of 100 hours of supervision must occur within a given semester. Collaborating teachers should submit this request to the ƵUniversity Supervisor of the pre-intern(s) or email to Dr. Jennifer Jacobs at jjacobs8@usf.edu after 300 hours have been accumulated. Approved requests will result in a Certificate of Participation being emailed or mailed to the collaborating teachers school address. Section A: To be completed by the Collaborating Teacher. Collaborating Teacher Name: _________________________________________________________________ Email: ______________________________________________________ Date: ________________________ School: ___________________________________________________________________________________ School Address: ____________________________________________________________________________ Street City Zip Please complete all sections for each pre-intern supervised. Pre-Intern NamePre-Intern ƵID (if known)School of SupervisionDates of Supervision (mm/dd/yy mm/dd/yy)Hours Hours must total 300 before request can be submitted. TOTAL HOURS: ____________ Collaborating Teacher Signature: ________________________________________________________________ Section B: To be completed by the ƵUniversity Supervisor. University Supervisor/Course Instructor Name: _____________________________________________________ Email: ______________________________________ Academic Program: _______________________________ The ƵUniversity Supervisor should submit this request to the Program/Field Coordinator from the academic program you are serving. After supervision hours have totaled 300, the request can be submitted to Student Academic Services for processing. By signing below, you are verifying the supervision hours reported by the collaborating teacher. ƵUniversity Supervisor Signature: ________________________________________________________________ Section C: To be completed by the Office of Field and Clinical Education. 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