CSU Field Experience Request Form
Welcome!  Congratulations on this next step to accomplishing your goals to becoming an Educator or gaining the educational field experience required to complete your course.
Please use this form as your formal request for field placement hours - MAKE SURE YOU HIT SUBMIT on this form or your request will not be received!!
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Email *
What is your CSU ID #? *
First Name *
Last Name Name *
What term are you requiring field placement hours for? *
Required
Course Professor Name *
Course Name and Number Requiring Field Placement Hours. (Example - PE 2800) Only list one course per form. *
What type of field placement(s) do you need? *
Required
What type of  specific experience is required for your class? *
Required
What is the total number of field experience hours that you need for this course? *
What is the grade level that you require? (you may select more than one). *
Required
Have you completed the CPS Field Experience or Student Teacher Application Process yet? If not, make sure you register and complete the background clearance process ASAP (for field exp registration form - be sure to put your CSU Director of Field Placement as the University Coordinator - Ms. LaKisha Hillard email: lhillard@csu.edu).  *
Have you received a background clearance approval from CPS? *
Please provide your telephone number *
If you have a pre-approved school placement site already put the name of the school here *
If you have geographical area preference please state that (South side, West side, hyde park etc.,)  or if it is school district other than CPS state that also - If no particular preference just type NONE. *
A copy of your responses will be emailed to the address you provided.
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