NCFE CACHE Supporting Teaching & Learning in Schools

Work Placement Supervision Agreement ( Witness Testimony )

I have been made aware of the work placement supervision requirements of this course and
agree to provide supervision and work experience support for the student named below:

STUDENT DETAILS

Your Name

Student Number

Date of
Commencement

Name of Placement
Organisation (school)

Address of Placement
(School Address0

Telephone Number
(School)

E-mail Address
(School)

I agree that any evidence provided will be a true reflection of the student’s performance and will be signed
by an appointed mentor within the organisation.

Teacher/Supervisor Name .......................................................................................................

Teacher/Supervisor Signature .......................................................................................................

Date ....................................................................................................................

When completed this form should be returned to with your unit assignment.

Observation/Witness Testimony
Student Name

Student Number

Date

Activity / Task

Assessment Criteria

Description of Activity Undertaken and Results/Outcomes Question No.

Please write a description of what you did in the classroom

to complete the practical task(s) in the assignment.

Description of Activity Undertaken and Results/Outcomes Question No.

( this form can be copied if additional space is required )

Teacher/Supervisor signature confirming this to be an accurate record

......................................................................................... Date.................................

Student signature........................................................... Date................................