Record of Field Experience Hours Completed
Student:____________________________ check one: ___ ECPK 481 ____ECPK 492
School/Center: _____________________________ Community:____________________
Site Supervisor:_________________________________________________________
If no person fits this category, leave blank
Scheduled Supervision Period Minimum of 4 weeks and 100 hours required for a 3-credit experience. Hours must be spent providing direct services to children, excluding naptimes. Students should follow the site schedule of holidays and breaks, not BSU’s.
Start Date: ________________________ Stop Date: __________________________
Mon.-Fri. Scheduled Times: ________________________________________________
| Supervision Week | Dates | Daily log of hours spent working in assigned classroom with children | Initials of Site Supervisor | Total Hours |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
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| 5 | ||||
| 6 | ||||
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| 8 | ||||
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| 10 | ||||
| 11 | ||||
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| 13 | ||||
| `14 | ||||
| 15 | ||||
| Total |
Site supervisor Signature: ___________________________ Date:____________________
Student Signature: __________________________________________ Date:_________
