Form: Field Experience Documentation- Undergraduate

Owner: Georgetown Administrator <Georgetownadmin>
Owner's Email: Edu_Data_Custodian@georgetowncollege.edu
Dataset: Field Experience Documentation - Undergraduate
EDIT: Y, VIEW: N, REQR: N
1
Last Name
EDIT: Y, VIEW: N, REQR: N
2
First Name
EDIT: Y, VIEW: N, REQR: N
3
Middle Name
EDIT: Y, VIEW: N, REQR: N
4
Enter your student ID number:
EDIT: Y, VIEW: N, REQR: N
5
Choose the semester of this field experience:
Fall
Interterm
Spring
Summer 1
Summer 2
EDIT: Y, VIEW: N, REQR: N
6
Choose the year of this field experience:
EDIT: Y, VIEW: N, REQR: N
7
Enter your course prefix and number (e.g. EDU542)
EDIT: Y, VIEW: N, REQR: N
8
Select your program level:
I am an undergraduate student.
I am a graduate student.
EDIT: Y, VIEW: N, REQR: N
9
If you are an undergraduate student, please select all areas that apply to you:
Elementary
Middle School: English/Communication
Middle School: Mathematics
Middle School: Science
Middle School: Social Studies
Secondary: Biology
Secondary: Chemistry
Secondary: English
Secondary: Mathematics
Secondary: Physics
Secondary: Social Studies
P-12: Art
P-12: French
P-12: German
P-12: Instrumental Music
P-12: Spanish
P-12: Vocal Music
EDIT: Y, VIEW: N, REQR: N
10
Field Experience Site Name:
EDIT: Y, VIEW: N, REQR: N
11
Field Experience School District:
EDIT: Y, VIEW: N, REQR: N
12
Name of On-Site Mentor:
EDIT: Y, VIEW: N, REQR: N
13
Date(s) of Field Experience:
EDIT: Y, VIEW: N, REQR: N
14
Total Clock Hours of this Field Experience:
EDIT: Y, VIEW: N, REQR: N
15
This Field Experience included the following:
Check all that apply
Observation at a school
Observation at a Family Resource Center
Observation at a Youth Services Center
Student tutoring
Interaction with families of students
Attendance at school board meetings
Attendance at school-based council meetings
Participation in a school-based professional learning community
Opportunities to assist teachers or other school professionals
EDIT: Y, VIEW: N, REQR: N
16
Select the grade level of the students you worked with:
Check all that apply
PK
K
1
2
3
4
5
6
7
8
9
10
11
12
worked with teachers/other school professionals
EDIT: Y, VIEW: N, REQR: N
17
Brief Description of Field Experience
EDIT: Y, VIEW: N, REQR: N
18
Total # of students:
EDIT: Y, VIEW: N, REQR: N
19
# of female students:
EDIT: Y, VIEW: N, REQR: N
20
# of male students:
EDIT: Y, VIEW: N, REQR: N
21
# of students on free or reduced lunch:
EDIT: Y, VIEW: N, REQR: N
22
# of English Language Learners:
EDIT: Y, VIEW: N, REQR: N
23
# of students with IEPs:
EDIT: Y, VIEW: N, REQR: N
24
# of gifted students:
EDIT: Y, VIEW: N, REQR: N
25
# of American Indian/Alaska Aleut:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
26
# of Asian:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
27
# of Hawaiian or Pacific Islander:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
28
# of White:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
29
# of two or more races:
(Non-Hispanic)