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Field Experience Placement Form
Name
*
First
Last
Email
*
Hometown
*
Major(s) / Minor(s)
*
If music major, select area
Select below...
Vocal
Instrumental
Cell Phone or Room Phone
*
###
-
###
-
####
Preferred Grade Level Placement
*
Preferred Content Area for Placement
*
Do you have your own transportation?
*
Yes
No
Do you have a valid drivers license?
*
Yes
No
Field Experience Applying For (Select all that apply)
*
BI/CH 470 Secondary Science Content Methods
ED 181 Foundations of American Education
ED 210 Children's Literature
ED 282 Secondary School
ED 284 Introduction to Mild and Moderate Disabilities
ED 324 Remedial Reading
ED 383 Educational Psychology
ED 385 Elementary School Reading
ED 481 Early Childhood Practicum
ED 491 Culture and Pedagogy of American Schools
SCI 385 Elementary Science Methods
MA 312 Teaching Elementary School Mathematics
MA 470 Secondary Content Math Methods
MU 181 FE Elementary General Music
MU 281 FE Secondary Choral/Instrumental Music
SW 210 Meeting the Needs
FREE BLOCKS OF TIME
It is important to find blocks of approximately 3 hours. This allows for time at your school plus driving time. Those who are taking Reading in the Elementary School need to realize most teachers teach reading in the morning.
Free blocks of time (MWF)
Free blocks of time (TTh)
Other free blocks of time
PREVIOUS PLACEMENTS
If you have done any previous field experiences while being enrolled at Wartburg please list them.
School1
School2
School3
Class1
Class2
Class3
Number of Hours1
Select below...
4 hours
6 hours
8 hours
10 hours
15 hours
25 hours
50 hours
Number of Hours2
Select below...
4 hours
6 hours
8 hours
10 hours
15 hours
25 hours
50 hours
Number of Hours3
Select below...
4 hours
6 hours
8 hours
10 hours
15 hours
25 hours
50 hours
Have you had a 25 hour placement in a diverse setting? (Waterloo schools, Wartburg West and New York May Term trips count for these 25 hours.)
*
Yes
No
If so, when?
If so, where?
Additional Comments
© Wartburg College - 100 Wartburg Blvd. - Waverly, IA 50677 - (800) 772-2085
