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Initial Licensure Field Evaluation 1.0
Placement Information
*
Student Teacher's Name
(Required.)
*
Student Teacher's Race
(Required.)
American Indian or Alaska Native
Asian or Asian American
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White or Caucasian
Mixed Race
Not Listed, Uncertain, or Prefer Not to Respond
*
Student Teacher's Endorsement Area
(Required.)
Early/Primary PreK-3
Elementary Education, PreK-6
Secondary English
Secondary History/Social Studies
Secondary Math
*
Placement Grade Taught
(Required.)
Pre-Kindergarten
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Middle School
High School
*
Internship Start Date (MM/DD/YYYY)
(Required.)
*
Internship End Date (MM/DD/YYYY)
(Required.)
*
School of Student Teaching Placement
(Required.)
*
School Division
(Required.)
Chesapeake Public Schools
Virginia Beach City Public Schools
Atlantic Shores Christian Schools
Other (please specify)
*
Evaluator's Name (First Last)
(Required.)
*
Evaluator's Email. We will return a PDF copy of your report to this address.
(Required.)
Email Address:
*
Evaluator's Position/Role
(Required.)
Classroom Teacher
School Administrator
Student Teacher (Self-Evaluation)
University Supervisor
University Department Chair
*
What time period is this evaluation for?
(Required.)
Mid-Term of Placement
Final Week of Placement
2 / 10
20%