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FIELD SERVICE PARTICIPATION FORM Math 391, Field Experience in the Public Schools, California State University, Northridge |
Student Name ___________________________________________________________
Participating School _______________________________________________________
Grade Level/Class _______________________________________ Room ___________
Assigned Hours __________________________________________________________
To the Teacher: It would be helpful to us if you would provide information regarding the performance of the student on the following quality indicators. Circle an appropriate measure on the sliding scale below. 0 indicates not applicable, 1 indicates unsatisfactory, and 5 indicates outstanding.
Student is receptive to new ideas and innovations.
0 1 2 3 4 5 Comments ________________________
Student takes direction well and works cooperatively with others.
0 1 2 3 4 5 Comments ________________________
Student is effective in communicating with secondary students.
0 1 2 3 4 5 Comments ________________________
Student works well with secondary students of diverse social and ethnic backgrounds.
0 1 2 3 4 5 Comments ________________________
Student is enthusiastic about the importance of mathematics in the education of the individual.
0 1 2 3 4 5 Comments ________________________
Number of hours the student spent in the classroom (check one):
Less than 45 hours __________ 45 or more hours ____________________
Comments ______________________________________________________________________ ______________________________________________________________________________
______________________________________________________________________________
Signature ________________________________________ Date _________________
Note: It is necessary that each supervising classroom teacher complete this form.