Exit Initial Licensure Field Evaluation 1.0 Placement Information Question Title * Student Teacher's Name Question Title * Student Teacher's Race American Indian or Alaska Native Asian or Asian American Black or African American Hispanic or Latino Native Hawaiian or other Pacific Islander White or Caucasian Mixed Race Not Listed, Uncertain, or Prefer Not to Respond Question Title * Student Teacher's Endorsement Area Early/Primary PreK-3 Elementary Education, PreK-6 Secondary English Secondary History/Social Studies Secondary Math Question Title * Placement Grade Taught Pre-Kindergarten Kindergarten First Grade Second Grade Third Grade Fourth Grade Fifth Grade Sixth Grade Middle School High School Question Title * Internship Start Date (MM/DD/YYYY) Question Title * Internship End Date (MM/DD/YYYY) Question Title * School of Student Teaching Placement Question Title * School Division Chesapeake Public Schools Virginia Beach City Public Schools Atlantic Shores Christian Schools Other (please specify) Question Title * Evaluator's Name (First Last) Question Title * Evaluator's Email. We will return a PDF copy of your report to this address. Email Address: Question Title * Evaluator's Position/Role Classroom Teacher School Administrator Student Teacher (Self-Evaluation) University Supervisor University Department Chair Question Title * What time period is this evaluation for? Mid-Term of Placement Final Week of Placement Page1 / 10 10% of survey complete. Next >>