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Field Experience Proposal Form

Student Name:_________________________________________ Valencia Student ID Number: V _________________________

I have received a request from ____________________________ to host a Directed Field Experience. I agree to assist and supervise the above named student. I understand that I am welcomed to contact Dr. Molly McIntire anytime during this field experience at (407) 582-5473 with any issues or concerns regarding this field experience. __________________________________________

Supervising Teacher Name

__________________________________________

Supervising Teacher Signature

__________________________________________

Supervising Teacher Email

__________________________________________

Grade Level

__________________________________________

Subject Area

__________________________________________

Date

__________________________________________

Host School Name

__________________________________________

Host School Address

___________________________________________ ___________________________________________

Host School Phone Number

___________________________________________

Principal Name

___________________________________________

Best Time to Contact

Comments:


/FieldExperienceProposalForm