Exit 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 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 K-12 Special Education- General Curriculum Reading Specialist Question Title * Placement Grade Taught Question Title * Internship (SPECIAL EDUCATION AND READING SPECIALIST ONLY)Select the type of internship being completed this semester. Please note that a Traditional Internship is for an intern that is not a contracted teacher and does not have a teaching license. A Non-Traditional Internship is for an intern that is completing an internship as a contracted teacher within a school division. This intern is already a provisionally or professionally licensed teacher. ETSP 561- Teaching Students with Exceptional Needs (Field Experience III)TRADITIONAL INTERNSHIP ETSP 561- Teaching Students with Exceptional Needs (Field Experience III) NON-TRADITIONAL INTERNSHIP ETSP 561A- Inclusions (Field Experience III) TRADITIONAL INTERNSHIP ETSP 561A- Inclusions(Field Experience III) NON-TRADITIONAL INTERNSHIP ETSP 596- Reading Specialist- TRADITIONAL INTERNSHIP ETPS 596- Reading Specialist- NON-TRADITIONAL INTERNSHIP Question Title * Internship Start Date (MM/DD/YYYY) Question Title * Internship End Date (MM/DD/YYYY) Question Title * School of Internship Placement Question Title * School Division 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 Cooperating Teacher School Administrator University Supervisor University Department Chair Question Title * In what semester is this internship being completed? Fall Semester Spring Semester Summer Semester Page1 / 10 10% of survey complete. Next >>
