RECORD OF EARLY FIELD EXPERIENCES
Center for Educator Certification & Academic Services
Texas A&M University-Commerce
Commerce, TX 75429-3011
Name:_____________________________________________ Social Security # or ID#:__________________
School District:_____________________________ School Campus:______________________________
Primary Mentor Teacher:__________________________________ Total Hours Completed:_______
Observation Dates: First Date________________ Last Date________________
Instructions: Complete this form and submit to your ELED/SED 300 Instructor. Make copies for your files. Use the space below to report on dates, time, & activities. Additional pages may be used if needed.
| DATE | HOURS | GRADE LEVEL | DESCRIPTION OF ACTIVITIES | MENTOR TEACHER INITIALS |
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TOTAL HOURS |
Primary Mentor Teacher: Your signature verifies the completion of the total field experience hours indicated to the left. |
Mentor Teacher’s Signature: __________________________________ Phone: _________________
Principal’s Signature: __________________________________ Phone: _________________