University Supervisor Initial Visit
Date of Visit (click on a date):
<November 2014>
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Current Status:
Intern Name:
Intern Email:
Clinical Educator Name:
Clinical Educator Email:
Content Area/Grade Level:
School:
Placement Begin/End Dates: (ie mm/dd/yyyy to mm/dd/yyyy)
School District:
University Supervisor Name:
University Supervisor Email:
1. On what date did the Intern first arrive?
<November 2014>
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2627282930311
2345678
9101112131415
16171819202122
23242526272829
30123456
2. Has the clinical educator reviewed the Student Teaching Internship Handbook?
3. Has the Intern reviewed the Student Teaching Internship Handbook?
4. On what date will the Intern begin to assume teaching/co-teaching responsibility?
<November 2014>
SuMoTuWeThFrSa
2627282930311
2345678
9101112131415
16171819202122
23242526272829
30123456
5. Has the Intern discussed and determined an appropriate topic for the TWS with clinical educator and university supervisor?
Please note the topic and dates for TWS lessons:
6. What is the timeline for the Intern to submit Teacher Work Sample Factor drafts to University Supervisor?
7. What is the timeline for both University/Clinical Educator formal observations of the Intern?
8. What will the Intern's responsibilities be with respect to maintaining a journal?
9. What specific requirements will the Intern need to complete for each University Supervisor visit?
10. What should the Intern and/or Clinical Educator do if questions or concerns arise during the Internship?
University Supervisor Signature:
Today's Date: 11/24/2014 8:15:27 AM