University Supervisor Initial Visit

Date of Visit

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Intern Name

Intern Email

Clinical Faculty

Clinical Faculty Email

Grade/Subject

School

Placement Begin/End Dates

School District

University Supervisor

University Supervisor Email

1. On what date did the intern first arrive?

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2. Has the clinical faculty reviewed the Student Teaching Internship Handbook?
YesNo

3. Has the intern reviewed the Student Teaching Internship Handbook?
YesNo

4. On what date will the intern begin to assume teaching/co-teaching responsibility?

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5. Has the intern discussed and determined an appropriate topic for the TWS with clinical faculty and university supervisor?
YesNo

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 faculty 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 faculty do if questions or concerns arise during the internship?

University Supervisor Signature

Date

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