<p> The Richard Stockton College of New Jersey Please Check One: SCHOOL OF EDUCATION ❒ Introductory Fieldwork Phone (609) 652-4688 Fax (609) 748-5528 ❒ Intermediate Fieldwork ❒ Ed. Psych. Fieldwork Fieldwork Placement Form</p><p>Please type or print all information</p><p>Term: (circle) Spring Summer Fall E-Mail Address: ______Name: (If not living at home, complete college address/phone below) Permanent Address: College Address/P.O. Box City, State, Zip: College Phone: Phone Major ______Z# ______</p><p>Please circle your fieldwork preference: </p><p>Elementary: K 1ST 2ND 3RD 4TH 5TH </p><p>Middle School Content Area: ( 6-8 ) English Mathematics Science Social Studies</p><p>Secondary: ( 9-12 ) Art Biological Science Chemistry Earth Science English French Latin Mathematics </p><p>Physics Physical Science Spanish Social Studies</p><p>Request for Sites: Please list your first, second, and third choice for fieldwork placement from the lists of schools on the back of this form. Do not list schools in which you have had personal or professional relationships (the school from which you have graduated, schools where family members are currently attending, schools in which you have completed fieldwork, substituted, etc.) Each elementary and secondary student must have at least one middle school fieldwork experience. Please Note: While students may request possible placement sites, the School of Education makes all placements. Placements cannot be changed once they are made by the school district. Students are not to contact districts, schools or teachers directly until they have received official notification from the School of Education.</p><p>** You should select a school district from each placement group ( urban, rural, suburban ) that you have not been previously placed in so that you have a diversified fieldwork learning experience. </p><p>** Placements are limited by the school district. If you do not get your first choice, we will try to place you in your second choice then third choice. </p><p>** From which high school did you graduate?______</p><p>Name of School District Type of School Placement Grade Level Elementary – (At least one middle school experience) Secondary – ( At least one middle school experience)</p><p>1st choice ______</p><p>2nd choice ______</p><p>3rd choice ______</p><p>Previous Placements: List previous school placements and substitute teaching experiences (list the school district):</p><p>Educational Psychology: </p><p>Intro Fieldwork: </p><p>Substitute/other Experience: </p><p>Once you receive confirmation of your placement, it is your responsibility to contact the school and your cooperating teacher!</p><p>Signature Date </p>