BHSU - Field Experience: Diversity 4c Form

Intern Initial Interview with Clinical Educator

Please complete this form as you take notes during the initial conversation with your placement's clinical educator. A copy of this initial interview form will be submitted to the clinical educator and the Office of Field Experiences.

This initial interview should be done within three weeks from the time you were informed of your placement or as soon as possible.

All interns will complete this initial interview for each placement.

Fill out the form below. For your convenience, here is a blank form you can print out to write on Intern Initial Interview with Clinical Educator. The clinical educator, the Field Experience Office and the intern should receive a pdf copy of this form.

Current Status:

Undergraduate Pre-Student Teaching (EDFN-595)

Undergraduate Pre-Student Teaching (SPED-495)

Undergraduate Pre-Student Teaching (ECE-495)

Undergraduate Pre-Student Teaching (ELED-495)

Undergraduate Student Teaching

Pre-Admission Student teaching (EDFN 595)

Graduate Pre-Student Teaching (ED 695)

Graduate Student Teaching

Intern Name:*

Intern Phone:

Clinical Educator Name:*

Clinical Educator Email:*

Clinical Educator Phone (if possible):

Date of Visit (MUST click on a date):*

mm/dd/yyyy

School:*

School Phone:

Content Area/Grade Level:*

Placement Begin Date (MUST click on a date):*

mm/dd/yyyy

Placement End Date (MUST click on a date):*

mm/dd/yyyy

1. When does the school semester begin? End?

2. When does the school day start (time)?

3. When does the school day end (time)?

4. What is the dress code in the school district?

5. What is the current contact information (email & phone #) for the clinical educator?

6. What curriculum is used in core subjects? Which textbooks and programs are used?

7. What are some extra-curricular duties I could be asked to do?

8. Are there special considerations specific to the school that I need to be aware of before starting the field experience? (Identification, IT training, security at the door, etc.):

9. Does the school have a teacher handbook?

10. Clicnical educator and intern may share some of their interests and hobbies:

Intern Signature:*

Today's Date: 4/25/2024 12:23:41 AM

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click the 'Submit' button ONCE in a session. If you unsure your form was submitted OR you got a 'critical error' notice in a pink box after form submission, please contact Kellie Hatch to verify if the form was submitted sucessfully.