BHSU - Field Experience: University Supervisor Meeting with Clinical Educator and Intern Form

University Supervisor Meeting with Clinical Educator and Intern Form

Current Status: *

Undergraduate Student Teaching

Graduate Student Teaching

Intern Name: *

Date of Visit (click on a date):

Clinical Educator Name: *

Clinical Educator Email: *

School:

School District:

Content Area/Grade Level:

Placement Begin/End Dates: (ie MM/DD/YYYY to MM/DD/YYYY)

University Supervisor Name: *

University Supervisor Email: *

Meeting Questions

1. Are the Clinical Educator and Intern present at this meeting?

Yes

2. Has the clinical educator received the Student Teaching Internship Handbook?

Yes

3. Did you review the website 'www.bhsu.edu/fieldexperience'?

Yes

4. Did you visit about implementing various co-teaching strategies?

Yes

5. Which co-teaching strategies do you plan to implement?

6. Did you discuss the protocol to give permission forms to the parents for the PPAT?

Yes

7. Did you discuss the PPAT work-sessions and due dates?

8. What is the timeline for both University/Clinical Educator formative observations of the Intern? (Schedule a tentative calendar for observations-Handbook page 33)

9. What will the Intern's responsibilities be with respect to maintaining a journal or weekly reflections, etc.?

10. What specific requirements will the Intern need to complete for each University Supervisor visit?

11. Did you review the checklist of responsibilities? (See handbook page 32)

Yes

12. What should the Intern and/or Clinical Educator do if questions or concerns arise during the Internship?

For any concerns after visiting with the University Supervisor, contact Jami Kesling, Office of Field Experience Director at Jami.Kesling@bhsu.edu or call: 605-642-6077

University Supervisor Signature (Type Full Name):

Today's Date: 6/12/2026 8:01:50 PM

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Important: Click the 'Submit' button ONCE in a session. If you are 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 successfully.