CARSON­NEWMAN COLLEGE
DIVISION OF EDUCATIONAL LEADERSHIP
JEFFERSON CITY, TN 37760
REQUEST FOR PRACTICUM/INTERNSHIP PLACEMENT
Education 525, Legal and Ethical issues
PLEASE PRINT OR TYPE ALL ITEMS EXCEPT THE SIGNATURE
MENTORING ADMINISTRATOR*_____________________________________________________
POSITION _________________________________ GRADES OF PRACTICUM _______________
SCHOOL/CENTRAL OFFICE: _______________________________________________________
INTERN NAME: ___________________________________________________________________
________________________________________________________________________________
MENTOR SIGNATURE (INDICATES APPROVAL OF ABOVE PLACEMENT) DATE
NOTE: The Tennessee State Board of Education requires that each individual enrolled in
an educational leadership class have involvement with a mentoring experience. In Education
525 the student must complete 25-hours of practicum experience related as nearly as possible
to the Legal and Ethical Issues involved in school operations.
Once completed, this form should be returned to:
Dr. Earnest Walker, Director
Educational Leadership
Carson-Newman College
CNC Box 72013
Jefferson City, TN 37760
*THE MENTOR MAY BE A PRINCIPAL, ASSISTANT PRINCIPAL, OR CENTRAL OFFICE ADMINISTRATOR/SUPERVISOR
HOLDING A VALID TENNESSEE ADMINISTRATIVE LICENSE.