1. Field Experience Info
Personal Info
1. Name/Year
2. Contact Info
a. Cell Phone #
b. Email Address
c. Parent/Guardian Info
3. Field Experience Placement Preferences – Please put in order of your
preference
a. School Choice
i.
ii.
b. Grade Level Choice
i.
ii.
c. Teacher Preference (if any)
i.
ii.
4. Transportation? (Circle one)
a. Yes
b. No