Student MUST complete this section
Semester: Fall □ Spring □ Year: ___________
Campus of Admission: DPC □ Poly □ Tempe □ West □
Semester in Program: Undergrad 1 □ 2 □ OR MAC /Grad 1 □ 2 □
Office of Clinical Experiences Paraprofessional Petition (Aide)
SPECIAL NOTE: For your paraprofessional setting to count as your clinical experience, the classroom setting must meet
your program requirements including grade and content area. Paraprofessional hours WILL NOT BE ACCEPTED FOR
STUDENT TEACHING. Student initials: ___________________
Directions: Complete this petition and return it to [email protected].
Affiliate ID#: __________________________________
ASU Email: _________________________________
Last Name ____________________________________
First Name: __________________________________
Phone: ___________________________ Are you an undergraduate or graduate student? _________________________
Program:
 ECS: Undergraduate Early Childhood/Early Childhood SPE
 ECD: MAC/Graduate Early Childhood Online
 BLE/ESL: Elementary Education/Bilingual Education/English as a Second Language
 EED: Elementary Education
 SED: Secondary Education: Content ______________________________
 SPE/EED: Special Education/Elementary Education Dual Certification
Explanation of Request: Please complete the following for your current paraprofessional position.
District: ____________________________________
Grade: ____________ Content: ________________________
School address: __________________________________________________________________________________
Intern Mentor Teacher Name: _______________________________________________________________________
Intern Mentor Teacher Email: _______________________________________________________________________
Signatures Required:
Intern: I agree to communicate my course requirements to my supervisor.
Signature: ________________________________________
Date: _________________________
Intern Mentor Teacher: I have read the requirements and agree to mentor my Paraprofessional in his/her internship.
Signature: ________________________________________
Date: _________________________
Principal: This meets my approval. I understand that ASU requires a current Student Placement Agreement and I will be
contacted if this is needed prior to ASU approval.
Signature: ________________________________________
For Office Use Only:
Date: _________________________
SPA required for final petition approval. SPA Expiration Date: ______________________
Date: ____________________ Approved
☐ Denied ☐
Signature: ______________________________________________
Comments: _______________________________________________________________________________________________
_________________________________________________________________________________________________________
4/20/2015
Paraprofessional Setting
Requirements for the use of paraprofessional (Aide) work hours as Clinical Experience credit:
1. The classroom setting must meet intern’s program requirements including grade and/or content (subject) area.
2. A staff member must assume the responsibility as Intern Mentor Teacher to the student. This staff member must sign
the petition which indicates the mentor understands the teaching requirements of the intern during the clinical
experience.
3. The student must fulfill the teaching requirements consistent with the level of study. The intern must also complete a
timecard to turn into the Clinical Experience Instructor at the end of the semester.
4. The Intern Mentor Teacher will be responsible for completing a midterm and a final evaluation of the student in Tk20.
The following are the purposes for clinical experience assignments:
 Fulfill coursework assignment
 Participation in an internship teaching experience
 Observe an Intern Mentor Teacher to increase one’s repertoire of strategies and skills
 Participate in meetings, duties, and classroom activities
 Tutor individual students
 Plan and conduct small group lessons
 Plan and teach lessons to the entire class
Internship Expectations
1. Participate in required Instructional Activities.
2. Fulfill coursework assignments of ASU’s faculty which include Clinical Experience course
requirements. Provide Intern Mentor Teacher with assignment requirements (interviews, case study,
assessment, etc.) at least one week in advance.
3. Observe Intern Mentor Teacher.
4. Participate in meetings and duties with Intern Mentor Teacher.
5. Tutor one or two students under the direction of an Intern Mentor Teacher.
6. Circulate among and assist individual students during group work.
4/20/2015