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Clinical Field Experience Verification Form - FPC - signed.pdf

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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: _____________Felicia MoretzBachelor of Science in Early Childhood EducationNCSaraECH-360: Instructional Methodologies for Teaching: Arts10.003/23/20205/17/2020creative beginnings2047177810
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 TitleBachelor of Science in Early Childhood EducationNCECH-360: Instructional Methodologies for Teaching: Artscreative beginnings20471778YesPublicSara DuggerCaldwell8282214699MoretzUrban1966 K Morganton Blvd SWLenoirUnited States[email protected]Felicia28645Early Childhood Learning C
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 INFORMATIONActivitiesPlease describe the activities completed (Independent Whole Group Instruction, Interview, Administrative Duties)

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Candidate Program, Felicia Moretz, Sara Dugger

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