Early Field Experience Music Education

Rev 9/16/15

Early Field Experience Music Education

Application Form

Please read about all field placement requirements needed in the Early Field Experience Handbook on the SOM Music Education Documents page (FBI, BCI & I, Resume, EHE Field Placement Form, Behavior Form, Activities with Minors Certification). In addition, you must fill out a Music Education Intent for Registration Form. This is due by October 1 for spring semester requests and by March 1 for fall semester to Tom Cook in Hughes 101D ().

Name:______Date:______

Advisor:______Request for (please circle one): Spring 20_____ Fall 20_____

Space is limited on a first come first serve basis. There will only be a small selection of placement locations per semester.

Request #1

First Choice Level: HS MS Elem Pre-K Type:Choral Strings Band General Music

(Please circle)

Second Choice Level: HS MS Elem Pre-K Type: Choral Strings Band General Music

(Please circle)

Time You Would Like Your Placement to Occur (ave. hours are based on 17 hours total):(Please circle) First Seven Weeks Second Seven Weeks Full 14 weeks Spring or Winter Break

(2 hrs 25 minutes a week)(2 hrs 25 minutes a week)(1 hr 13 minutes a week) (You must have a faculty member agree to evaluate you and have the Area Head’s permission.)

Total Hours in Building Requested (17hrs suggested):______

Days and Times available for Field Experience: ______

Do you have a car? ______If not, can you carpool? Please include the name of the person(s) with

whom you will carpool. ______

Request #2

First Choice Level: HS MS Elem Pre-K Type: Choral Strings Band General Music

(Please circle)

Second Choice Level: HS MS Elem Pre-K Type: Choral Strings Band General Music

(Please circle)

Time You Would Like Your Placement to Occur (ave. hours are based on 17 hours total):(Please circle) First Seven Weeks Second Seven Weeks Full 14 weeks Spring or Winter Break

(2 hrs 25 minutes a week)(2 hrs 25 minutes a week)(1 hr 13 minutes a week) (You must have a faculty member agree to evaluate you and have the Area Head’s permission.)

Total Hours in Building Requested (17hrs suggested):______

Days and Times available for Field Experience: ______

Do you have a car? ______If not, can you carpool? Please include the name of the person(s) with

whom you will carpool. ______