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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 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
K-12 Special Education- General Curriculum
Reading Specialist
*
Placement Grade Taught
(Required.)
*
Internship (SPECIAL EDUCATION AND READING SPECIALIST ONLY)
Select the type of internship being completed this semester.
Please note that a
Traditional Internship
is for an intern that is not a contracted teacher and does not have a teaching license.
A
Non-Traditional Internship
is for an intern that is completing an internship as a contracted teacher within a school division. This intern is already a provisionally or professionally licensed teacher.
(Required.)
ETSP 561- Teaching Students with Exceptional Needs (Field Experience III)TRADITIONAL INTERNSHIP
ETSP 561- Teaching Students with Exceptional Needs (Field Experience III) NON-TRADITIONAL INTERNSHIP
ETSP 561A- Inclusions (Field Experience III) TRADITIONAL INTERNSHIP
ETSP 561A- Inclusions(Field Experience III) NON-TRADITIONAL INTERNSHIP
ETSP 596- Reading Specialist- TRADITIONAL INTERNSHIP
ETPS 596- Reading Specialist- NON-TRADITIONAL INTERNSHIP
*
Internship Start Date (MM/DD/YYYY)
(Required.)
*
Internship End Date (MM/DD/YYYY)
(Required.)
*
School of Internship Placement
(Required.)
*
School Division
(Required.)
*
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.)
Cooperating Teacher
School Administrator
University Supervisor
University Department Chair
*
In what semester is this internship being completed?
(Required.)
Fall Semester
Spring Semester
Summer Semester
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