Teacher Education

ESOL Practicum Site Form

Please review the requirements below before submitting the ESOL Practicum Site Form:

Read the Practicum Procedure Form
Find a practicum site (Some districts may require you to go through Human Resources. Check with the school site first.)
Please remember that it may take up to two weeks for practicum site approval (processing request, assigning supervisor, etc.)

If you have questions contact Marjorie Synakiewicz at marjorie@lclark.edu or 503-768-6104.

Name

E-Mail

Phone Number

Practicum Site

Practicum Site Address

Practicum Site Phone Number

Start Date

End Date

Days

Times

Grade Level

Number of Students

Total

Does this classroom require the ESOL endorsement?

Yes

Does this classroom require instruction in ESL/ELD?

Yes

Does this classroom require instruction to be sheltered?

Yes

Name of mentor teacher

Mentor's email address

Mentor completed their ESOL program at

Name of institution

Have you completed Form PA-1 (Required by TSPC)?

Yes

Notes