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BALDWIN WALLACE UNIVERSITY


Division of Education
Berea, Ohio 44017

FIELD EXPERIENCE VERIFICATION FORM

Course Number: EDU- _________ Semester/Year: _____________________

Student Name: __________________________________ Student I.D.: ________________________

Hours Completed: ___________

Cooperating Teacher: ________________________________________________________________

Grade: ___________________________________________________________________________

School: ___________________________________________ District: ________________________

Address: __________________________________________________________________________
Street City State Zip

Briefly Describe Field Experience:

Evaluation of Field Experience:

_____ Satisfactory _____ Unsatisfactory ______________________________


Cooperating Teacher

____________________________
Date

_____ Satisfactory _____ Unsatisfactory ____________________________


University Professor

____________________________
Date
Revised September 2012

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