University Supervisor Meeting with Clinical Educator and Intern Form

Current Status: Undergraduate Student Teaching Graduate Student Teaching

Intern Name: Please select one

Date of Visit (click on a date): < April 2025 > Su Mo Tu We Th Fr Sa 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10

Clinical Educator Name:*

Clinical Educator Email:*

Content Area/Grade Level:

School:

Placement Begin/End Dates: (ie mm/dd/yyyy to mm/dd/yyyy)

School District:

University Supervisor Name:*

University Supervisor Email:*

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

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

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

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

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? YesNo

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) YesNo

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 email: Jami.Kesling@bhsu.edu or call: 605-642-6077

University Supervisor Signature:

Today's Date: 4/29/2025 10:08:08 AM

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