Child Development and Education Program

Child Development and Education Program (Early Field Experiences) Student Observer PLACEMENT APPLICATION FALL, 2017

NAME:______last 4 digits of SS#:______

ADDRESS:______CITY:______ZIP:______

HOME PHONE:______CELL PHONE:______

EMAIL ADDRESS:______DEPARTMENT LEAD: _ Dr. Elaine Zweig______PHONE: (972) 881-5967 ______

AREA OF CERTIFICATION (SUBJECT):______

CERTIFICATION LEVEL: ______

TOTAL NUMBER OF OBSERVATION HOURS REQUIRED:______16 hours______

SCHOOLS REQUESTED: 1)______2)______3)______GRADE LEVEL REQUESTED: 1)______2)______3)______TEACHER REQUESTED: 1)______2) ______3)______Please note: Placement in the schools of your choice may be requested, but is NOT guaranteed. Please list ALL McKinney ISD schools in your volunteer application. PROGRAM COORDINATOR’S SIGNATURE:______Date:______

Placement Confirmation to be completed by ______

Date Criminal Background Approved:______Date of Placement:______

School Name:______Observation Start Date: ______

Address:______Zip:______

Principal:______School Phone:______

Cooperating Teacher:______Email:______

Grade Level/Subject:______Teacher’s Phone:______

______(For McKinney ISD Only)______Special Instructions to the Student Observer: Once placement is confirmed, student is responsible for communicating with the assigned teacher to schedule specific observation dates and times. *If your child/children attend school in this district, please provide name(s) of these schools. *If a relative works in a school in this district, please provide name(s) of these schools. You will NOT be permitted to observe your own child(ren)’s campus or relative’s campus.

My Child/Children attend: ______My Relative works:______Please return to: Glenda Strange, Lab School Instructor – Child Development and Education Program [email protected]. Collin College – 2800 East Spring Creek Parkway, Plano, TX 75074