Intern Initial Interview with Clinical Educator

Please complete this form as you take notes during the initial conversation with your placement's clinical educator. A copy of this initial interview form will be submitted to the clinical educator and the Office of Field Experiences.

This initial interview should be done within three weeks from the time you were informed of your placement or as soon as possible.

All interns will complete this initial interview for each placement.

Fill out the form below or print the Intern Initial Interview with Clinical Educator form. Clinical educator, the Field Experience office and yourself should have a copy.

Date of Visit (click on a date):*
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Current Status:
Intern Name:*
Intern Email:*
Intern Phone:
Clinical Educator Name:*
Clinical Educator Email:*
Clinical Educator Phone (if possible):
School:*
School Phone:
Content Area/Grade Level:*
Placement Begin Date (click on a date):*
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Placement End Date (click on a date):*
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1. When should I plan on contacting the clinical educator prior to the beginning date?
2. When does the school day start (click on a date)?*
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3. When does the school day end (click on a date)?*
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4. What is the dress code in the school district?
5. What curriculum is used in core subjects? Which textbooks and programs are used?
6. What is the timeline for the Intern to submit Teacher Work Sample Factor drafts to University Supervisor?
7. What are some extra-curricular duties I could be asked to do?
8. Are there special considerations specific to the school that i need to be aware of before starting the field experience? (Identification, IT training, security at the door, etc.):
9. Does the school have a teacher handbook?
10. Clicnical educator and intern may share some of their interests and hobbies:
Intern Signature:*
Today's Date: 12/19/2014 10:57:37 PM