Field Experience Request Submission Instructions
Submitting Field Experience Request
Step 1: Instructor Completes the Field Experience Form
- Use black ink only.
- Complete one form per class section for each school campus placement i.e. each individual school campus will have a separate field experience form.
- Complete all sections on the form (see below). Incomplete forms will not be processed
and will be returned for completion.
- Rubric/Course title – list the course rubric and class name.
- Class day/time – list when the class meets on the school campus.
- Total number of candidates – list how many students are enrolled in the class.
- Suite Secretary – list suite secretary’s name.
- Field Experience/Activities/Duties should describe what tasks the student will be performing on the school campus i.e. observing one time, teaching four times, etc.
- School District must be listed.
- Campus name must be listed.
- Grade level – list grade level at which the experience will take place.
- Dates of visits – dates on which the students will be on the school campus. DO NOT WRITE “TBD”. Request forms submitted without an approximate start date will not be processed.
- Times of visits – Approximate times at which the students will be on the school campus
- Number of students per visit – list the number of students to be placed at the school campus.
- Employee information – any student employed with the district should be listed, including their position title and employee ID#, if applicable.
- NOTE: students employed with the district are still required to complete a background information form and undergo a criminal background check.
Step 2: Attach Class Roster
- Print roster in a large font to be easily read.
- If students listed on the roster are attending different districts or school campuses, please mark their names out on the roster.
- Rosters should indicate only those students for which the request is being submitted.
Step 3: Program Verification Letter
- Include verification letter if required per district instructions.
- The Program Verification Letter (Sample), if required by the district, must contain
the following information:
- On university/program letterhead
- Student’s name
- Semester and year
- Course name and number
- Instructor’s telephone number
- Instructor’s email
- District requested
- Campus requested
- Statement of need to complete observation hours or field experience
- Signed by instructor and dated
Step 4: Syllabus
Include a syllabus if required per district instructions
Step 5: Submission to CPDT Office
Submit the following documents to the CPDT Office who will obtain approval from the district and notify you when students may proceed.
- Field Experience Request Form
- Class Roster
- Verification Letter (if required by district)
- Course Syllabus (if required by district)
Please cc: your suite secretary on all field experience communication to the CPDT Office.
Step 6: Instructors
- Keep a copy of submitted field experience request forms.
- DO NOT retain a copy of a student's criminal history form, doing so is both unacceptable and illegal.
- Inform students when school district approvals have been obtained.
- Inform students of where to go, whom to contact, time to report, etc.