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Please fill out the information for your internship below.

* 1. YOUR First Name

* 2. YOUR Last Name

* 3. Your NLU ID Number (begins with an "N")

* 4. Internship Supervisor's (principal's) FIRST NAME

* 5. Internship Supervisor's (principal's) LAST NAME

* 6. Internship Supervisor's (principal's) TITLE

* 7. Name of School

* 8. School Grade Level

* 9. Internship Supervisor's (principal's) EMAIL ADDRESS

* 10. Internship Supervisor's (principal's) OFFICE MAILING ADDRESS (Street, City, State Zip)

* 11. How many years has the internship supervisor been in his or her CURRENT position?

* 12. School Size (student population)

* 13. Percentage of Free/Reduced Price Lunch Students in School (Poverty Indicator)

* 14. Percentage of Racial/Ethnic Minority Students in School

* 15. Percentage of English Language Learner Students in School

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