Form: Field Experience Log

Owner: NCE Office of the Dean <ncedean>
Owner's Email: daniel.sloyan@nl.edu
Dataset: Field Exp Observation Logs 2014+
EDIT: Y, VIEW: N, REQR: N
1
Instructions: This form allows you to enter one of the schools that you may have visited as part of your field experience -- You must complete this form for each facility you visit. Start as many additional new forms as necessary. What is your LAST name?
Upon completion of this form: 1.) Click "Submit Form" 2.) Click on "Create a Printable Version" 3.) Share your submission: Copy the URL (or Web Address), Print the submission, Bookmark the site, or "Save As" in your records.
EDIT: Y, VIEW: N, REQR: N
2
What is your FIRST Name?
EDIT: Y, VIEW: N, REQR: N
3
What is your student ID#? (i.e. N00120304)
EDIT: Y, VIEW: N, REQR: N
4
To which course are you submitting this field experience / observation log?
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5
Please enter the name of the facility that you observed. Then enter the name of the Classroom teacher/School-based mentor and his/her contact information in case we need to confirm your visit.
EDIT: Y, VIEW: N, REQR: N
6
What is the 18 character RCDTS Code of the facility at which you observed? (You may look it up at http://www.isbe.state.il.us/sis/html/rcdts.html) If this was not an Illinois-affiliated institution, please type "NA" for Not Applicable.
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7
Please indicate the number of hours you observed at this facility.
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8
Please indicate the content areas you observed.
Select all that apply
English Language Arts
Foreign Language
Math
Reading
Science
Social Studies
Fine Arts
Other
EDIT: Y, VIEW: N, REQR: N
9
What geographic location best describes the location of this observation.
EDIT: Y, VIEW: N, REQR: N
10
Please choose which School Type best describes the facility you observed.
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11
What was the approximate number of students you observed at this location?
Please provide a number only
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12
To the best of your ability, please indicate which exceptional learning needs you observed during your experience.
Autism
Cognitive Disability
Emotional Disability
Deafness
Deaf/Blindness
Hearing Impaired
Multiple Disabilities
Orthpedic Impairment
Specific Learning Disabilty
Specific Language Impairment
Traumatic Brain Injury
Visual Impairment
Other Health Impairment (e.g. limited strength, vitality or alertness)
EDIT: Y, VIEW: N, REQR: N
13
During these field experiences, if you encountered any of the following, please select all that apply.
Check all that apply
Assessed student learning (small group)
Assessed student learning (large group)
Led/taught lesson or activty
Led a classroom discussion
Observed/worked with ESL students
Were involved in IEP development
Were involved with arranging a classroom
Observed/worked with Gifted/Talented students
Were involved in rearranging a classroom
Used educational technology
Used data to guide instruction
Implemented behavioral strategies
Worked with community members/families
Utilized/aligned lessons to Illinois Learning Standards
Utilized/aligned lessons to Common Core
Differentiated lessons
Utilized reading, writing, and/or oral communication in lessons
Collaborated as a team member
Participated in School Safety Drills
Proctored standardized testing activities
Attended/Participated in parent conferences
Attended/Participated in staff meetings or School Board meetings
Attended/Participated in service learning activities
Attended/Participated in Conference/Webinar
Consulted/interviewed/observed an expert in the field
EDIT: Y, VIEW: N, REQR: N
14
Do you attest this information is correct?
Yes
No
Upon completion of this form: 1.) Click "Submit Form" 2.) Click on "Create a Printable Version" 3.) Share your submission: Copy the URL (or Web Address), Print the submission, Bookmark the site, or "Save As" in your records.