Wednesday, April 10, 2019
Preliminary Information Request
Dear Touro Student,
I am pleased to be your fieldwork or practicum instructor. I look forward to making this an enjoyable and rewarding experience. This letter will give you some important information. Details will be explained in our first (of 3) mandatory group meetings. The first Group Meeting for your field experience or practicum course, will be held on Wednesday or Thursday, 1/17 or 1/18, at our Kings Highway location between 7:45pm and 9:15pm. Full details including a map will be on our class website click on Practicum.
To better assist you, please answer all questions on this form and email it back to me. In addition, please bring a completed copy to Group Meeting 1. Please save this file in the following manner. Create a folder with your student “zz” number in My Documents. Save this file into that folder, but change the name. Delete the 6246 at the beginning of the filename and replace it with your class ###zz number, which can be found on the students page of our website link. Remember to close MS word before attaching the file to your email. The subject of your email MUST begin with your student ###zz number for recognition. Often I delete emails not easily recognized.
Please complete the information by replacing each set of asterisks (**) with information requested
Touro Student Information
Last name, first name: **
Telephone: **
Cell: **
Email address: **
Touro ID: **
Class ###zz number: **
Course (include letters): **
1. I have a copy of the course guide (yes, no): **
2. I have received fingerprint results from NYCDOE and I am approved: ** (yes or no)
If you are in process, please explain: **
3. Are you currently teaching (yes, no): **
If yes, name and number of the school: **
Name of principal: **
Address: **
School Tel. number: **
4. Do you have a schools where you are approved to conduct your work, with principal’s permission? Yes or No: **
If “No” please explain when this will be in place: **
Information on locations to complete your practicum or fieldwork
5. Placement 1 information.
Name the school and number: **
Name of principal: **
School Address: **
School Tel. number: **
Name of the supervisor of your work: **
Title: **
Cooperating teacher’s full name: **
Class: **
Grade: **
Room: **
License: **
Type of class: **
Number of hours you expect to complete with this cooperating teacher: ** hrs.
Course requirement area (Special Ed. or General Ed.): **
6. Placement 2 information.
Name the school and number: **
Name of principal: **
School Address: **
School Tel. number: **
Name of the supervisor of your work: **
Title: **
Cooperating teacher’s full name: **
Class: **
Grade: **
Room: **
License: **
Type of class: **
Number of hours you expect to complete with this cooperating teacher: ** hrs.
Course requirement area (Special Ed. or General Ed.): **
7. Are you fingerprinted by NYCDOE (yes, no): **
If you are in process, please explain: **
8. Please explain where and how and where you will complete working with the following groups:
Children with Special Learning Needs: **
Diverse Population: **
English Language Learners: **
HighNeedsSchool: **
Enumerate any questions you might have in completing your course requirements. In this manner I can address them in our meeting.
1: **
2: **
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File: 6246studentinfo