MSUM ED 794 PRACTICUM

INFORMATION FORM

(Please fill out one form for each Practicum you enroll in)

STUDENT NAME: ________Ara Anderson______STUDENT NUMBER:___14358163_____________

Practicum Title and Year/Semester Enrolled:__MN Principal Licensure__Summer 2019____________

This Practicum is part of:_______________Principal Licensure__(Elementary)_________________

(Indicate degree, licensure, credential you are pursuing via this Practicum)

Present Position______K-12 Instructional Technology Coach_________________________________________

Work Address: ______Deer River Public Schools ISD 317 101 1st Ave NE Deer River, MN 56636_______

(MSUM will use your MSUM email for all email correspondence.  Please check this frequently)

MSUM SUPERVISOR/INSTRUCTOR ______Julie Swaggert_____________________

SITE SUPERVISOR (licensed administrator for school personnel, work place administrator for all others)

NAME:_______Jennifer Stefan

POSITION:______Principal_____________________________________

WORK ADDRESS:_____ Deer River Public Schools ISD 317 101 1st Ave NE Deer River, MN 56636__

PHONE:___________218-246-8241 ex 60401_______________________________

EMAIL:___________jstefan@isd317.org____________________________________