Application to Providefield-Based Experiences(Fbe) Out-Of-State

APPLICATION TO PROVIDEFIELD-BASED EXPERIENCES(FBE) OUT-OF-STATE

OR IN A U.S. TERRITORY PLACEMENT

19 Texas Administrative Code (TAC)§228.35(d)(4)(A): All Department of Defense Education Activity (DoDEA) schools, wherever located, and all schools accredited by the Texas Private School Accreditation Commission (TEPSAC) are approved by the TEA for purposes of field-based experience, internship, student teaching, clinical teaching, and/or practicum.

[19 TAC§228.35(d)(4)(B)]:An EPP may file an application with the TEA for approval, subject to periodic review, of a public school, a private school, or a school system located within any state or territory of the United States, as a site for field-based experience or for video or other technology-based depiction of a school setting.

General Provisions: The educator candidate seeking certification as a classroom teacher must complete a minimum of 30 hours of Field-Based Experiences (FBE) as detailed in 19 TAC §228.35(a)(3) and 19 TAC §228.35(d).

Notice: The contents of this application are confidential to the extent allowed by law.

EPP INFORMATION
EPP Name:
County District Number:
Contact Person:
Address:
City:State:Zip:
Phone:
Email:Website:
Submission Date: Desired Start Date:

Assurances

The educator preparation program (EPP) will ensure, as applicable, that the candidate will experience:

(1) a minimum total of 30 clock hours of field-based experiences (FBE) in a variety of educational settings with diverse student populations; and

(2) a minimum of 15 of the total 30 clock hours where the candidate is actively engaged in instructional or educational activities under supervision. In addition, FBE should also include introductory experiences for a certification candidate involving interactive and reflective observation of Early Childhood-Grade 12 students, teachers, and faculty/staff members engaging in educational activities in a school setting that reflect:

(A) authentic school settings in a public school accredited by the Texas Education

Agency (TEA) or other school approved by the TEA for this purpose;

(B) instruction by content certified teachers;

(D) content or grade level specific classrooms/instructional settings;

(E) variable time length of observation; and

(F) reflection of the observation..

______

Signature of EPP RepresentativeTitle

______

Printed Name of AboveDate

Submit one email copy of the completed application, including assurances, with a delivery/read receipt .

Insufficient information in any area of the application may delay approval. Approval of this application may take several weeks. Please keep time constraints in mind when submitting the application. There is currently no fee associated with this application.

CANDIDATE INFORMATION
Name of Candidate:
TEA Identification Number:
CertificationSought:
Address:
City:State:Zip:
Phone:
Email:

Note: If all 30 FBE hours will be completed out of state, they must be completed on a minimum of at least two (2) different campuses. [19 TAC §228.35(d)]

STATE/ US TERRITORY/ SCHOOL DISTRICT/CAMPUS PLACEMENT INFORMATION (1)
Name of State/U.S. Territory (1):
Name of School District/Campus (1):
U. S. Territory/School District/Campus Accreditation(s):
Contact Person:
Address:
City:State: U. S. Territory: Zip:
Phone:
Email:
Website:
STATE/ US TERRITORY/ SCHOOL DISTRICT/CAMPUS PLACEMENT INFORMATION (2)
Name of State/U.S. Territory (2):
Name of School District/Campus (2):
U.S. Territory/School District/Campus Accreditation(s):
Contact Person:
Address:
City: State: U.S. Territory: Zip:
Phone:
Email:
Website:

In the space below, identify the circumstances that necessitate this request to complete FBEoutside ofthe State of Texas. [19 TAC §228.35(d)(4)(B)]

______military assignment

______illness of candidate or family member

______caretaker of family member

______Other

If other, explain:

In Sections A below, provide information that aligns the destination state/U.S. territory educator standards with the Texas educator standards for the certification category sought by the candidate. In Section B, provide information that aligns the destination state/U.S. territory K-12 learning standards with the Texas Essential Knowledge and Skills (TEKS) for each grade level within the certification category sought by the candidate. Use Sections C and D to record the standards alignment information for the second placement IF the candidate will be completing FBE in two (2) placements with different standards. [19 TAC §228.35(d)(4)(B)]

Section A: Complete the educator standards cross-walk comparisonfor Placement 1.

SBEC Educator Standards and PPR Standards for the Certificate Area/Grade Level Being Sought (include all knowledge and skills indicators within each standard) / Destination State/U.S. Territory’s Correlating Educator Standards and Pedagogy Standards for the Certificate Area/Grade Level Being Sought / For TEA Use Only
A D
A D
A D
A D
A D
A D

Section B: Complete the TEKS cross-walk comparison for Placement 1

TEKS for the Certificate Area/Grade Level(s) Sought (include all knowledge and skills indicators within each standard) / Destination State/U.S. Territory’s Correlating K-12 Learning Standards for the Certificate Area/Grade Level (s) Sought / For TEA Use Only
A D
A D
A D
A D
A D
A D

Section C: Complete the educator standards cross-walk comparison for Placement 2 (only if the standards are different from those in Placement 1).

Section D: Complete the TEKS cross-walk comparison for Placement 2 (only if the standards are different from those in Placement 1)

Complete Sections III – VI by typing responses directly below the prompt in each section.

Describe the type of documentation that will be accepted by the EPP as verification of completion of the FBE hours. (Attach related documents that will be provided to the candidate). [19 TAC §228.35(a)(3)]

Describe the guidance that will be provided to the candidate for completion of the FBE requirements. Include the requirements for the candidate reflections of the experiences. (Attach related documents that will be provided to the candidate).

[19 TAC §228.35(d)(1)]

Describe the measures that will be taken by theEPP to ensure that the candidate’s experience will be equivalent to that of a candidate in a Texas public/private school accredited by TEA. [19 TAC §228.35(a)(3) & §228.35(d) & §228.35(d)(4)(B)]

Provide any other information that may be beneficial in considering this request. [19 TAC §228.35(d)(4)(B)]