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CLINICAL FIELD EXPERIENCE VERIFICATION FORMCANDIDATE NAMESTUDENT NUMBERPROGRAM: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:Takrinda SholtzBachelor of Science in Elementary EducationAZLisa DennyELM-480: Methods and Strategies for Teaching English Langua15.0011/9/20201/17/2021Grand Canyon University2061247115.00
Clinical Field Experience Verification FormPlacement Course TitleCANDIDATE INFORMATIONLast NameFirst NameStudent NumberCandidate Program of StudyCOURSE INFORMATIONFACILITY INFORMATIONFacility NameType of FacilityFacility SettingOther FacilityAddressCityStateZip CodeCountrySCHOOL INFORMATIONSchool ClassificationTitle One (I)School DistrictPrincipal/Administrator NamePrincipal/Administrator PhonePrincipal/Administrator EmailBachelor of Science in Elementary EducationAZELM-480: Methods and Strategies for Teaching English Language ArtsGrand Canyon University20612471Not labeledPrivateBrian Mueller6026397500SholtzUrban3300 W Camelback RdPhoenixUnited States[email protected]Takrinda85017Other
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 NameMentorEmailAddress*Mentor PhoneNumberMentor GradeLevel*School/Work Email address requiredPRACTICUM INFORMATIONActivities

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Term
Summer
Professor
MaryBeth Nippe
Tags
Teaching English as a foreign language, Disposition, Adaptive expertise, Lisa Denny

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