Site Mentor

Submit the completed application with your electronic signature.  Basic Information Complete all required fields The Lamar internship spans the entire Masters program which is an 18-month program. You are expected to begin intern activities immediately following completion of EDLD 5311 and stay active as an intern throughout your degree program. * Degree or Professional Cer tifications M.Ed. In Educational Administration M.Ed in Educational Technology Preparation Program for Principal Certification * Cohort Group # or Program Starting Date (MM/YY) 10/2012 Name: Mary Lou Stout * Lamar Student ID # L20181261 * SS# * Address 6905 Windy Cove Circle * City Corpus Christi * State Texas * Zip 78414 * Primary Contact Number (s) 361-510-7384 * Work Number 361-994-5051 * Email jimmarylou@yahoo.com  Site Mentor Information In most cases, interns choose their building principal to be the Site Mentor. In some unique cases, interns choose an assistant principal or a principal at another school for a variety of reasons, including the principal not having the time to supervise or other reason. If you change schools or your Site Mentor changes schools, retires, etc., you will need to choose another Site Mentor and let your professor know. * Name of Site Mentor Barbara Massey * Title Technology Section Leader * Site Mentor's Email: bimassey@ccisd.us Alternative email: * Preferred Contact Phone # 361-232-9397 Region (1-20) * District Corpus Christi * School Name Ella Barnes Elementary * Address Oso Parkway * City Corpus Christi * State Texas * Zip 78414  Texes Teaching Certificate / Service Record Please note that verification that a student has the appropriate number of creditable years of teaching experience and/or valid Texas teaching certificate is required for Texas Principal certification. The valid Texas teaching certificate is required for Texas Principal Certification. Please attach a copy of your valid Texas Teaching Certificate here: No file attached Attach a copy of your Service Record from an approved agency here: No file attached  Intern Signature By submitting your electronic signature, you agree to the role and terms of an intern from the Internship handbook. Understand that your application will be reviewed for final approval. x By submitting your electronic signature, you agree to the role and terms of an intern from the Internship handbook. Understand that your application will be reviewed for final approval. Date 11/11/2012