Field Experience Request Submission Instructions

Submitting Field Experience Request

Step 1: Instructor Completes the Field Experience Form

•  Field Experience Request Form

Instructions:

• 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
  • 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.