University Supervisor Meeting with Clinical Educator and Intern Form
Current Status:
Intern Name:
Date of Visit (click on a date):
<July 2020>
Clinical Educator Name:*
Clinical Educator Email:*
Content Area/Grade Level:
Placement Begin/End Dates: (ie mm/dd/yyyy to mm/dd/yyyy)
School District:
University Supervisor Name:*
University Supervisor Email:*
1. Are the Clinical Educator and Intern present at this meeting?
2. Has the clinical educator received the Student Teaching Internship Handbook?
3. Did you review the website ''?
4. Did you visit about implementing various co-teaching strategies?
5. Which co-teaching strategies do you plan to implement?
6. Did you discuss the protocol to give permission forms to the parents for the PPAT?

7. When do you submit the PPAT Task 1 to the university supervisor?
8. What is the timeline for both University/Clinical Educator formative observations of the Intern? (Schedule a tentative calendar for observations-Handbook page 1)
9. What will the Intern's responsibilities be with respect to maintaining a journal or weekly reflections, etc.?
10. What specific requirements will the Intern need to complete for each University Supervisor visit?
11. Did you review the checklist of responsibilities?
12. What should the Intern and/or Clinical Educator do if questions or concerns arise during the Internship?

For any concerns after visiting with the University Supervisor, contact Sharla Dowding, Office of Field Experience Director email: or call: 605-642-6077

University Supervisor Signature:
Today's Date: 7/2/2020 1:21:04 PM

Please click the 'Submit' button ONCE in a session. If you are unsure if your form was submitted, contact Jean Osborn at for verification.