Fieldwork Verification Form
Email address *
First Name *
Last Name *
Student ID# *
Email *
Phone Number
Expected Graduation Term *
Expected Graduation Year *
Undergraduate Program *
Please check off specializations that are on your Degree works (For Education Sciences major) only)
Type of Fieldwork being verified *
For Course fieldwork only - please indicate courses taken with embedded fieldwork
For Course Fieldwork only- Please add any other courses taken previously with embedded fieldwork
Organization Name *
Start Date *
MM
/
DD
/
YYYY
End Date *
MM
/
DD
/
YYYY
Total Number of hours completed *
Is this site listed on the Online Fieldwork Catalog   *
Site Supervisor *
Supervisor Email *
Supervisor Phone number
Supervisor Verification of hours
Please upload verification letter written on company letterhead. The letter should have the following information: 1) Student's full legal name 2) Start and end dates of fieldwork 3) Total number of fieldwork hours completed 4) Contact Information and supervisor and organization 5) General Description of activities including details about age group (needed for specializations).
Please upload letter of verification (outside fieldwork) or syllabus (course fieldwork) *
Required
Please take a moment to rate your overall impression of this fieldwork site *
Unsatisfactory
Outstanding
I received necessary and appropriate training at my fieldwork site *
Strongly Disagree
Strongly Agree
I spent less than 10% of my time doing clerical work (filing, copying, answering phones, scanning, documents, data entry) *
Strongly Disagree
Strongly Agree
My fieldwork supervisor(s) provided adequate feedback and supervision *
Strongly Disagree
Strongly Agree
I performed personal tasks/errands for my mentor or other employees less than 10% of my time *
Strongly Disagree
Strongly Agree
What was the most valuable aspect of your fieldwork experience?
Please add any additional comments or feedback about this site and your fieldwork experience
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