OTTERBEIN COLLEGE
DEPARTMENT OF EDUCATION
APPROVAL FORM FOR NON-CREDIT FIELD EXPERIENCE
To help teacher education students meet State mandated clinical and field experience requirements, certain non-credit activities related to children may be recorded. To be acceptable for this purpose, the activity must be approved in advance and in writing by an Otterbein College faculty member, be supervised, be evaluated and be reported to the Education Department at the conclusion of the experience. No financial exchange is implied.
This form is to be completed prior to starting the experience.
Name of Student
Agency Providing Experience
Agency Address
Agency Phone
Supervisor
Description of Activity
Start Date / Completion Date / No. of Hours
Approval
We approve the activity described for field experience credit.
Agency Approval
/College Approval
Signature
/Signature
Title
/Title
Date
/Date
OTTERBEIN COLLEGE
DEPARTMENT OF EDUCATION
EVALUATION OF NON-CREDIT FIELD EXPERIENCE
This form is to be used by the supervisor of approved non-credit field experience related to children or instruction to evaluate the experience and report it to the college. The report will permit recording he experience in the student’s teacher education file to count toward the State mandated clinical and field experience requirements for teacher licensure.
To be acceptable for this purpose, the field experience must:
1)be approved in writing by an Otterbein College faculty member
2)be supervised, and
3)be evaluated and reported to the Education Department at the conclusion of the experience.
Name of Student
Agency Providing Experience
Agency Address
Agency Phone
Supervisor
Description of Activity
Start Date / Completion Date / No. of Hours
Supervisor: Please check√ the scale where appropriate.
Additional comments may also be attached on a separate piece of paper.
Excellent / Good / Average / PoorDependability
Maturity and Judgment
Communication Skills
Leadership Skills
Planning
Additional Comments
Approval
We approve the activity described for field experience credit.
Agency Approval
/College Approval
Signature
/Signature
Title
/Title
Date /Date
EDUCATION DEPARTMENT
FIELD EXPERIENCE TIME SHEET
Name of Student / Course
Cooperating Teacher / Grade/
Assignment
School District / School
Date (MMDDYY) / Time in / Time Out / Total time / Cumulative
continued on reverse
Total Field Experience Hours
fieldexperience fill in.doc
9/10/18/cfp