This document requests personal information including name, contact details, and parent/guardian information from a student for a field experience placement. It also asks the student to rank their preferences for school, grade level, and teacher for the placement and whether they need transportation assistance.

1. Field Experience Info
Personal Info
1. Name/Year
2. Contact Info
a. Cell Phone #
b. Email Address
c. Parent/Guardian Info
3. Field Experience Placement Preferences – Please put in order of your
preference
a. School Choice
i.
ii.
b. Grade Level Choice
i.
ii.
c. Teacher Preference (if any)
i.
ii.
4. Transportation? (Circle one)
a. Yes
b. No