Field Placement Survey Spring 2010

In order to assist the Education Department at SUNY Orange in making an appropriate field placement, please answer the questions below.

*Questions preceded by an asterisk (*) are required to be completed.

*
1. Please enter your contact information below:

Please enter your contact information below: First Name
Last Name
SUNY Orange Email Address (If you do not want to check this email account, please set up your college email to forward to your personal email.)
Phone Number (Cell or home)

*
2. Select the class that you are enrolled in (that requires field observation hours)

Select the class that you are enrolled in (that requires field observation hours) EDU 103 Introduction to Early Childhood (Wednesday at 11:00am) Middletown

EDU 103 Introduction to Early Childhood (Wednesday at 4:00pm) Middletown

EDU 202 Infant & Toddler Development & Curriculum (Thursday at 9:30am) Middletown

EDU 103 Introduction to Early Childhood (Thursday at 6:00pm) Newburgh

*
3. Please select your top 3 choices for a geographical area to which you would be able to travel for your field placement.

Please note, that while we will try our best to place you according to your preferences, we cannot guarantee that we will be able to do so.

	1st Choice	2nd Choice	3rd Choice
Chester	*Please select your top 3 choices for a geographical area to which you would be able to travel for your field placement. Please note, that while we will try our best to place you according to your preferences, we cannot guarantee that we will be able to do so. Chester 1st Choice	Chester 2nd Choice	Chester 3rd Choice
Cornwall	Cornwall 1st Choice	Cornwall 2nd Choice	Cornwall 3rd Choice
Florida	Florida 1st Choice	Florida 2nd Choice	Florida 3rd Choice
Goshen	Goshen 1st Choice	Goshen 2nd Choice	Goshen 3rd Choice
Middletown - Placements in the Middletown School District will not be available at this time	Middletown - Placements in the Middletown School District will not be available at this time 1st Choice	Middletown - Placements in the Middletown School District will not be available at this time 2nd Choice	Middletown - Placements in the Middletown School District will not be available at this time 3rd Choice
Milford	Milford 1st Choice	Milford 2nd Choice	Milford 3rd Choice
Minisink	Minisink 1st Choice	Minisink 2nd Choice	Minisink 3rd Choice
Monroe	Monroe 1st Choice	Monroe 2nd Choice	Monroe 3rd Choice
Montgomery	Montgomery 1st Choice	Montgomery 2nd Choice	Montgomery 3rd Choice
New Windsor	New Windsor 1st Choice	New Windsor 2nd Choice	New Windsor 3rd Choice
Newburgh	Newburgh 1st Choice	Newburgh 2nd Choice	Newburgh 3rd Choice
Pine Bush	Pine Bush 1st Choice	Pine Bush 2nd Choice	Pine Bush 3rd Choice
Port Jervis	Port Jervis 1st Choice	Port Jervis 2nd Choice	Port Jervis 3rd Choice
Warwick	Warwick 1st Choice	Warwick 2nd Choice	Warwick 3rd Choice
Washingtonville	Washingtonville 1st Choice	Washingtonville 2nd Choice	Washingtonville 3rd Choice
West Point	West Point 1st Choice	West Point 2nd Choice	West Point 3rd Choice

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4. Which grade level do you prefer?

Which grade level do you prefer? Infant Room (appropriate for first half semester placement EDU 202)

Pre-K (appropriate for first half semester placement EDU 103)

Primary: K-2 (appropriate for EDU 103 first half semester placement)

Intermediate: 3-6 (appropriate for EDU 103 second half semester placement)

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5. Do you have a special request for a particular placement site?

Do you have a special request for a particular placement site? Yes

Comments:

6. If you selected, yes, you have a special placement request; please complete the information below as specifically as possible:

If you selected, yes, you have a special placement request; please complete the information below as specifically as possible: Name of site:
Site address:
Site phone number:
Director/Principal's name:
Teacher's name:
Your connection to this site:

7. Is there anything else you think we need to know in order to help select a field placement for you?

Is there anything else you think we need to know in order to help select a field placement for you?

Field Placement Survey Spring 2010
Exit this survey

1. Spring 2010 - Field Placement Survey

*
1. Please enter your contact information below:

*
2. Select the class that you are enrolled in (that requires field observation hours)

*
3. Please select your top 3 choices for a geographical area to which you would be able to travel for your field placement.

Please note, that while we will try our best to place you according to your preferences, we cannot guarantee that we will be able to do so.

*
4. Which grade level do you prefer?

*
5. Do you have a special request for a particular placement site?

6. If you selected, yes, you have a special placement request; please complete the information below as specifically as possible:

7. Is there anything else you think we need to know in order to help select a field placement for you?

Field Placement Survey Spring 2010Exit this survey

1. Spring 2010 - Field Placement Survey

*1. Please enter your contact information below:

*2. Select the class that you are enrolled in (that requires field observation hours)

*3. Please select your top 3 choices for a geographical area to which you would be able to travel for your field placement.Please note, that while we will try our best to place you according to your preferences, we cannot guarantee that we will be able to do so.

*4. Which grade level do you prefer?

*5. Do you have a special request for a particular placement site?

6. If you selected, yes, you have a special placement request; please complete the information below as specifically as possible:

7. Is there anything else you think we need to know in order to help select a field placement for you?

Field Placement Survey Spring 2010
Exit this survey

*
1. Please enter your contact information below:

*
2. Select the class that you are enrolled in (that requires field observation hours)

*
3. Please select your top 3 choices for a geographical area to which you would be able to travel for your field placement.

Please note, that while we will try our best to place you according to your preferences, we cannot guarantee that we will be able to do so.

*
4. Which grade level do you prefer?

*
5. Do you have a special request for a particular placement site?