CREC Schools Placement Form
This form must be completed by individuals completing classroom observation hours, student teaching placements, internships, or research. Complete this form only if your placement has been confirmed by Laura Lyon as well as the receiving school.

CREC requires documentation of all individuals who will have access to school facilities and students.

Name
Your answer
Email
Your answer
Phone Number
Your answer
School Affiliation
Please select the school or institution who is sponsoring your placement
Required
School Supervisor/Contact
Please give the name and contact information for your program supervisor or contact person if applicable.
Your answer
Type of Placement
Required
Partnering Teacher(s) or Administrator(s)
Please name the teacher(s) or administrator(s) with whom you will be working. Please also designate their position, grade level, and/or content area if applicable
Your answer
Partnering School
Please select the school(s) where you will conduct this placement
Required
Start Date
When will your placement start? Approximate dates are acceptable.
MM
/
DD
/
YYYY
End Date
When will your placement end? Approximate dates are acceptable.
MM
/
DD
/
YYYY
Other Dates
If your placement does not have a specific start/end date, please list all dates in which you will be fulfilling your placement.
Your answer
Car Make, Model, and License Plate Number
Please provide this information if you will be parking your vehicle on school property
Your answer
Emergency Contact Information
Please provide the name and contact information for at least ONE emergency contact. This may include a personal physician.
Your answer
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