. Georgia Southern University COLLEGE OF EDUCATION Department of Leadership, Techn and Huma lopment SUPERVISED FIELD EXPERIENCE SCHOOL-BASED MENTOR AGREEMENT FORM 2 Fall Spring nA Year aos (Canetdat) Boece Oy A Q \ has enrolled this semester in Education Leadership Field Experience |/ II / Ill, This student is requesting permission to complete this field experience under your supervision. The department requests that the student select activities from the Supervised Field Experiences Form, or experiences aligned with the Georgia Education Leadership Standards. The student must spend at least 125 hours during the course while also actively participating in other program course work. These hours may be arranged at the convenience of the school- based mentor and the student. Responsibilities of the school-based mentor include: 1. To work collaboratively with the student's university supervisor. 2. To arrange for the student to have a minimum of 125 hours of work on administrative activities per semester. Students are expected to include activities that require before and active school time. 3. To ensure that the student experiences a wide variety of activities agreed upon by you, including the student's participating in a half-day observation each at the elementary, middle, high school, and district levels. 4. To assist the University Supervisor in evaluating the performance of the student. Ifyou agree to serve as the candidate's school-based mentor and accept the responsibilities as listed above, please complete the following: School-based Mentor Name Position an ee ree GAPSC Certificate # 4os 150 District. School.