Wartburg College Teacher Field Experience Sign-up

Thank you for your willingness to supervise a Wartburg College education student. Please fill out the form below to identify what field experience(s) and dates/times you would be able to work with our students.

**The state of Iowa has recently adjusted how it handles licensure renewal. Teachers can now acquire up to one licensure credit for the work they do with field experience students and student teachers. If you are interested in this opportunity please contact Bill Soesbe at bill.soesbe@wartburg.edu about the specifics and/or follow this link to download the needed documentation http://www.wartburg.edu/cce/fieldexperiences/renewal.doc.

1) Wartburg College and the local school districts have established criteria that must be met in order for a teacher to serve as a supervisor for a field experience student or student teacher. They include:

    1. Possess an Iowa professional teaching license
    2. Certified in the area of teaching
    3. Three years of successful teaching experience

By entering your e-mail below you are verifying that you meet these criteria.

Please enter your e-mail:

3) First Name:

4) Last Name:

5) School:

If you selected other, please specify:

6) Please identify what level you primarily teach.

7) Specific Grade Level(s):

8) Subject Area(s):

9) How do you want students to initially contact you about his/her assigned placement?

Phone

Doesn't matter

10) Phone number (if you indicated you wanted to be contacted via this method) students can get ahold of you to arrange the assigned field placement:

11) Number of students you are willing to work with in a semester:

12) Number of students you are willing to have in your classroom at one time:

13) If it does not matter what types of placements are made with you and you trust my judgement, check yes below and I will determine what placement best fits your needs and the needs of the education department. Question 14 allows you to add any additional comments. If you checked yes you can scroll to the bottom of this survey and submit.

If you want to specify what placements are made please go to question number 15 and complete the rest of the survey.

Yes it does not matter...place as you best see fit.

14) Additional comments.

16) When would you be available to supervise this/these field experience(s)?

Additional comments:

17) Please indicate the field experiences in which you would be willing to work in conjuction with our pre-service teachers. Please note that each field experience pertains to the specific grade levels that have been identified.

I would be willing to supervise (a) student(s) in the following field experiences during Winter Term (Jan.-Apr.):

	(check all that apply)
Remedial Reading (1-3) - 30 hours	Remedial Reading (1-3) - 30 hours (check all that apply)
Teaching Elementary School Math (K-6) - 6 hours (students come in pairs)	Teaching Elementary School Math (K-6) - 6 hours (students come in pairs) (check all that apply)
Field Experience in Elementary General Music (K-8) - 15 hours	Field Experience in Elementary General Music (K-8) - 15 hours (check all that apply)
Foundations of American Education (PK-12) - 25 hours	Foundations of American Education (PK-12) - 25 hours (check all that apply)
Educational Psychology (PK-12) - 25 hours	Educational Psychology (PK-12) - 25 hours (check all that apply)
Teaching in Secondary Schools (7-12) - 15 hours	Teaching in Secondary Schools (7-12) - 15 hours (check all that apply)
Culture and Pedagogy (7-12) - 15 hours	Culture and Pedagogy (7-12) - 15 hours (check all that apply)

Additional comments:

18) When would you be available to supervise this/these field experience(s)?

Additional comments:

19) Please indicate the field experiences in which you would be willing to work in conjuction with our pre-service teachers. Please note that each field experience pertains to the specific grade levels that have been identified.

I would be willing to supervise (a) student(s) in the following field experiences during May Term:

	(check all that apply)
Children's Literature (K-6) - 3 hours	Children's Literature (K-6) - 3 hours (check all that apply)
Early Childhood Practicum (PK-2) - 50 hours	Early Childhood Practicum (PK-2) - 50 hours (check all that apply)

Additional comments:

20) When would you be available to supervise this/these field experience(s)?

Additional comments:

21) Student Teaching (for the NEXT academic year):

I would be willing to supervise a student teacher during

22) If you requested a student teacher, how long would you like to work with him or her?

23) Please provide any information about yourself and/or your classroom that you would like to share with your field experience student(s):

Thank you for providing your information and for your willingness to strengthen the field of education by helping our pre-service teachers grow personally and professionally.

Bill Soesbe
Director - Office of Student Field Experiences
School Partnerships Coordinator
Wartburg College
100 Wartburg Blvd
Waverly, Iowa 50677
cell# (319) 415-9852
work# (319) 352-8446
fax# (319) 352-8702
email bill.soesbe@wartburg.edu
website http://www.wartburg.edu/cce/fieldexperiences.html

	(check all that apply)
Children's Literature (K-6) - 3 hours	Children's Literature (K-6) - 3 hours (check all that apply)
Reading in the Elementary School (1-3) - 15 hours	Reading in the Elementary School (1-3) - 15 hours (check all that apply)
Elementary Science Methods (K-8) - 6 hours (students come in pairs)	Elementary Science Methods (K-8) - 6 hours (students come in pairs) (check all that apply)
Introduction to Mild and Moderate (PK-8) - 25 hours	Introduction to Mild and Moderate (PK-8) - 25 hours (check all that apply)
Foundations of American Education (PK-12) - 25 hours	Foundations of American Education (PK-12) - 25 hours (check all that apply)
Educational Psychology (PK-12) - 25 hours	Educational Psychology (PK-12) - 25 hours (check all that apply)
Teaching in Secondary Schools (7-12) - 15 hours	Teaching in Secondary Schools (7-12) - 15 hours (check all that apply)
Culture and Pedagogy (7-12) - 15 hours	Culture and Pedagogy (7-12) - 15 hours (check all that apply)
Secondary Choral/Instrumental Music Methods (5-12) - 8 hours	Secondary Choral/Instrumental Music Methods (5-12) - 8 hours (check all that apply)
Secondary Science Content Methods (7-12) - 15 hours	Secondary Science Content Methods (7-12) - 15 hours (check all that apply)
Secondary Math Content Methods (7-12) - 9 hours	Secondary Math Content Methods (7-12) - 9 hours (check all that apply)