Field Placement Survey Spring 2012

1. Spring 2012 - Field Placement Survey

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.

Question Title

* 1. 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)

Phone Number (Home)

Question Title

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

EDU 103 EJ - Intro. to Early Childhood/Childhood Education Wednesday 6:00 - 8:45pm (Middletown)

EDU 103 NP - Intro. to Early Childhood/Childhood Education Thursday 2:00-4:50pm (Middletown)

EDU 202 M - Infant and Toddler Curriculum Thursday 12:00-1:50pm (Middletown)

Question Title

* 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	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
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
Valley Central	Valley Central 1st Choice	Valley Central 2nd Choice	Valley Central 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

Question Title

* 4. Which grade level do you prefer?

Child Care Center: (infant or toddler room appropriate for EDU 202 placement)

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

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

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

Question Title

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

Yes

Comments:

Question Title

* 6. 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:

Question Title

* 1. Please enter your contact information below:

Question Title

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

Question Title

* 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.

Question Title

* 4. Which grade level do you prefer?

Question Title

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

Question Title

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

Question Title

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

* 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.