Department of Special Education
Program in Behavior Disorders
Confirmation Form for Fieldwork Hours (SPED 702)
Semester ________________ Year ______________
Course: ___SPED 702 (20 hours) ___SPED 751 (15 hours)
Course Instructor: ______________________
Graduate Student’s Name ____________________________________
_________________________________________________________
Name, Number (e.g., P.S. 112), and Boro of school in which engaged in your fieldwork
Name of Teacher(s) in whose classroom(s) you participated/observed:
1. ______________________________________ Grade level: _____
2. ______________________________________ Grade level: _____
Complete this section for fieldwork conducted in multiple classrooms
Dates and Times of Fieldwork Teacher/Administrator Signature
1. _________________ 1. _________________
2. _________________ 2. _________________
3. _________________ 3. _________________
4. _________________ 4. _________________
5. _________________ 5. _________________
6. _________________ 6. _________________
7. _________________ 7. _________________
8. _________________ 8. _________________
9. _________________ 9. _________________
If all fieldwork hours were conducted in the same classroom, the teacher/administrator can sign here to indicate that that ___hours were served
_________________________________
Signature of Teacher/Administrator
*Note to cooperating teacher: Thank you for helping us to train a future colleague. Your consent to allow him/her to visit in your classroom is greatly appreciated.
Coordinator of the Graduate Program in Behavior Disorders
Thomas.mcintyre@hunter.cuny.edu
www.BehaviorAdvisor.com (the world’s most popular classroom management web)
I pledge that I have engaged in all the fieldwork hours identified above.
________________________________ _________________
Graduate student signature Date