Course Hero Logo

Clinical Field Experience Verification Form - FPC - signed (3).pdf

Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. This preview shows page 1 - 4 out of 5 pages.

CLINICAL FIELD EXPERIENCE VERIFICATION FORMCANDIDATE 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: _____________Elisee EugeneMaster of Education in Special EducationWIStephanie OlsonSPD-560: Language Development with Mild to Moderate Disab9.009/5/201910/16/2019Wedgewood Park International205114409
Clinical Field Experience Verification FormCANDIDATE INFORMATIONLast NameFirst NameStudent NumberCandidate Program of StudyCOURSE INFORMATIONFACULTY INFORMATIONFacility NameType of FacilityFacility SettingOther FacilityAddressCityStateZip CodeCountrySCHOOL INFORMATIONSchool ClassificationTitle One (I)School DistrictPrincipal/Administrator NamePrincipal/Administrator PhonePrincipal/Administrator EmailPlacement Course TitleMaster of Education in Special EducationWISPD-560: Language Development with Mild to Moderate Disabilities and DisordersWedgewood Park International20511440YesPublicElhadji NdawMilwaukee Public School414 604 7805EugeneUrban6506 W Warnimont AveMilwaukeeUnited States[email protected]Elisee53220Middle School
Clinical Field Experience Verification FormMENTOR INFORMATIONThis is the person directly supervising the practicum/field experience activities. Note: This is NOT the GCUcourse instructor. Example: Teacher, Administrator, Director, etc.Mentor NameMentor EmailAddress*Mentor PhoneNumberMentor GradeLevel*School/Work Email address requiredPRACTICUM INFORMATIONActivities

Upload your study docs or become a

Course Hero member to access this document

Upload your study docs or become a

Course Hero member to access this document

End of preview. Want to read all 5 pages?

Upload your study docs or become a

Course Hero member to access this document

Term
Spring
Professor
N/A
Tags
Individualized Education Program, Adaptive expertise, Stephanie Olson

Newly uploaded documents

Show More

Newly uploaded documents

Show More

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture