Field Supervisor

Field Consultant Report

Name of Intern *

First Name Last Name

Intern E-mail *

Visit #

Level *

Form of Visit

resident, resident/virtual, virtual

Practicum Site *

Practicum Site

Address

City State/Province/District

Postal / Zip Code Country

Type of Practicum *

If supervised, name of supervising teacher

Date of Visit *

Time of Visit *

Summary of Points of Evaluation- These are based on observations by the Field Supervisor, review of documents provided by the intern, and interviews with the intern, supervising teacher, and school administrator. See Practicum Visit Guidelines for criteria for evaluation.

	Proficient- meets and exceeds expectations for position	Developing - meets expectations for position with progress demonstrated	Basic- demonstrates essential skill	Not Observed- Unable to evaluate due to circumstances noted in comments. (Disclaimer: formal lessons not presented during observation time may result in delay of practicum completion.)
Preparation of Environment
Initiative/Motivation
Teamwork/Relations with Colleagues
Parent Communications
Lesson Planning and Record-Keeping
Overall Evaluation

Montessori Lesson (s) Observed *

# of Children *

Comment *

Montessori Lesson(s) Observed

# of Children

Comment

Overall Comments *

Field Supervisor *

First Name Last Name

Field Supervisor E-Mail *

Images/Samples

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(Optional)

Observation Journal Reviewed *

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Field Supervisor: Pressing the Submit button distributes this form to the

to the Business Office.