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Clinical Field Experience Verification Form - Findlay 4.10.19.pdf

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CLINICAL FIELD EXPERIENCE VERIFICATION FORM CANDIDATE NAME_________________________ STUDENT NUMBER_____________PROGRAM: ____________________________________________________________________________________ COURSE: _____________________________________________________ START DATE: ____________________________ END DATE: _____________________ PRACTICUM/FIELD EXPERIENCE FACILITY NAME: __________________________________________________________ SCHOOL STATE: ___________________________________ MENTOR NAME: ___________________________________________________________ TOTAL PRACTICUM/FIELD EXPERIENCE HOURS REQUIRED: ______________ TOTAL PRACTICUM/FIELD EXPERIENCE HOURS COMPLETED: _____________ Georgia MccoyMaster of Education in Special EducationNCCary FindlayESL-523: English Language Teaching Foundations & Methods10.003/7/20194/17/2019McKee Road Elementary205370326
Clinical Field Experience Verification FormCANDIDATE INFORMATIONLast NameFirst NameStudent NumberCandidate Program of Study COURSE INFORMATIONFACULTY INFORMATIONFacility NameType of FacilityFacility SettingOther FacilityAddressCityStateZip CodeCountrySCHOOL INFORMATIONSchool ClassificationTitle One (I)School DistrictPrincipal/Administrator Name Principal/Administrator Phone Principal/Administrator Email Placement Course TitleMaster of Education in Special EducationNCESL-523: English Language Teaching Foundations & MethodsMcKee Road Elementary20537032YesPublicLane PriceCharlotte Mecklenburg Schools980-343-3970MccoySuburban4101 McKee RoadCharlotteUnited States[email protected]Georgia28270Elementary School
Clinical Field Experience Verification FormMENTOR INFORMATION This is the person directly supervising the practicum/field experience activities. Note: This is NOT the GCU course instructor. Example: Teacher, Administrator, Director, etc.Mentor NameMentor Email Address *Mentor Phone NumberMentor Grade Level*School/Work Email address requiredPRACTICUM INFORMATIONActivities Please describe the activities completed (Independent Whole Group Instruction, Interview, Administrative Duties)

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Term
Summer
Professor
VIERLING
Tags
English as a foreign or second language, Adaptive expertise, Georgia Mccoy, Cary Findlay

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