Placement Request Form: EDS 137 & 139 (Summer 2018)
Welcome to the PAL (Partners At Learning) Program

We are the service-learning division of UC San Diego's Department of Education Studies.

Before completing this form, please carefully review the following details:

All new EDS practicum students are required to complete a background check form. Please visit:, complete and print the "clearance form" and return to EDS offices, 3rd floor of Pepper Canyon Hall.

Do NOT enroll in any PAL course if you have previously failed an EDS practicum course, have been convicted of a felony, or are required to register as a sex offender.

Students who have previously withdrawn from any EDS practicum course should consult with the PAL Director, Caren Holtzman (, before submitting this placement form.

A TB test is required. Bring a copy of the results with you to the first day of class. You may receive your TB test through the Student Health Center. A TB test is valid for 12 months, however, some schools/districts may require a more recent TB test and additional screening. You will be advised accordingly once you receive your school placement during the first week of class.

If you have a friend or roommate you'd like to take the class with, we can put you at the same school site and in the same discussion section.

If you don't have transportation we will place you at a school near public transportation or help you find a carpool. Zipcars are also a transportation option:

This PAL class meets twice a week. Attendance is mandatory in all lectures and discussions.

All PAL classes require a minimum of 40 field hours. These hours must be logged consistently throughout the quarter and completed by the end of Summer Session I. To complete your 40 hours make sure to reserve approximately 6-8 hours per week during school hours.

Notes on Media Use:
You agree to authorize UC San Diego’s Education Studies Program to use and reproduce any and all pictures featuring you.

Notes on Internet Policy:

1. PAL students are not authorized to share their email or any other personal internet information with PK-12 students.

2. We strongly recommend PAL students remove or use privacy settings for any questionable social networking site information (e.g. facebook, blogs, youtube, etc.) Parents or school personnel who find your information offensive or inappropriate may request your termination at your school site placement. Use your privacy settings!

Partners at Learning
I have read and understand the requirements for enrolling in a PAL course. I am eligible and agree to all terms. *
Never submit passwords through Google Forms.
This form was created inside of UC San Diego. Report Abuse - Terms of Service - Additional Terms