Form: Field Experience Documentation - Advanced Programs

Owner: Georgetown Administrator <Georgetownadmin>
Owner's Email: Edu_Data_Custodian@georgetowncollege.edu
Dataset: FP Documentation Advanced Programs
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
Georgetown College Email Address
EDIT: Y, VIEW: N, REQR: N
5
Enter your student ID number:
EDIT: Y, VIEW: N, REQR: N
6
Choose the semester of this field experience:
Fall
Interterm
Spring
Summer 1
Summer 2
EDIT: Y, VIEW: N, REQR: N
7
Choose the year of this field experience:
EDIT: Y, VIEW: N, REQR: N
8
Enter your course prefix and number (e.g. EDU542)
EDIT: Y, VIEW: N, REQR: N
9
Field Experience Site Name:
EDIT: Y, VIEW: N, REQR: N
10
Please select all areas that apply to you:
Teacher Leader Master of Arts
Teacher Leader Endorsement (no MA)
ESL Endorsement
GT Endorsement
IT Endorsement
Literacy Specialist Endorsement
Reading Endorsement
Environmental Education Endorsement
MSD Certificate
Rank I School Improvement
Learning and Behavior Disorders P-12
EDIT: Y, VIEW: N, REQR: N
11
Field Experience School District:
EDIT: Y, VIEW: N, REQR: N
12
Date(s) of Field Experience:
EDIT: Y, VIEW: N, REQR: N
13
Total Clock Hours of this Field Experience:
EDIT: Y, VIEW: N, REQR: N
14
Select the grade level of the P12 students and/or teachers you worked with:
Check all that apply
P-5
6-8
9-12
worked with teachers/other school professionals
EDIT: Y, VIEW: N, REQR: N
15
Brief Description of Field Experience
EDIT: Y, VIEW: N, REQR: N
16
Total # of students:
EDIT: Y, VIEW: N, REQR: N
17
# of female students:
EDIT: Y, VIEW: N, REQR: N
18
# of male students:
EDIT: Y, VIEW: N, REQR: N
19
# of students on free or reduced lunch:
EDIT: Y, VIEW: N, REQR: N
20
# of English Language Learners:
EDIT: Y, VIEW: N, REQR: N
21
# of students with IEPs:
EDIT: Y, VIEW: N, REQR: N
22
# of gifted students:
EDIT: Y, VIEW: N, REQR: N
23
# of Hispanic (any race):
EDIT: Y, VIEW: N, REQR: N
24
# of American Indian/Alaska Aleut:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
25
# of Asian:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
26
# of Hawaiian or Pacific Islander:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
27
# of White:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
28
# of Black or African American:
(Non-Hispanic)
EDIT: Y, VIEW: N, REQR: N
29
# of two or more races:
(Non-Hispanic)