As director of this host school, I affirm that the classroom(s) listed below were approved by:
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The form on this page is for an online application and payment for MIA certificate and MIA website presence of Practicum Site(s) by a Host School.


If you would prefer to download a PDF version of the application to complete and save on your computer or to fill in by hand, download the file below. 

A Practicum Site is defined as an operating classroom, with regularly enrolled children, which is qualified to allow an Adult Learner to perform their practicum. A Host School is the school where the Practicum Site is located.

A Practicum site is usually affiliated with a Teacher Education Program (TEP). A representative from the Teacher Education Program, or an MIA ON-Site Reviewer, evaluates and verifies that the Practicum Site meets the qualifications as defined in the MIA Certification Standards and Procedures.

Practicum Site certification is for a period of 1 year from date of certification.