ELEMENTARY PRACTICUM PLACEMENT REQUEST
SEMESTER___________20_____
READ AND FILL OUT THE ENTIRE FORM – FRONT AND BACK.
Course
Course Name/No. _____________________ Section # __________ Instructor: _______________________
Circle area(s) of interest: B-K
K
1
2
3
4
5
Other: _______________________
Name (PRINT) _______________________________ ECU Banner ID B___________ Phone # ____________
Last
First
Local Address: ____________________________________________________________________________
Assignment Request: You are responsible for transportation to and from your assignment.
_____ Pitt County Schools *NOT a guarantee; due to high numbers you may be placed in surrounding counties
_____ A county other than Pitt ** Specify COUNTY and SCHOOL: _______________________________________
Are you a Teacher Assistant at this school? _____ Yes _____ No
*IMPORTANT: Pitt County includes: Ayden, Bethel, Belvoir, Chicod, Falkland, Farmville, Greenville, Grifton, Grimesland, Pactolus, Stokes, and Winterville
areas. Be aware that all of these areas are used in making placements. It is not possible for everyone to be placed in Greenville City. There is no ECU or Greenville
transit system to all of these schools.
**IMPORTANT: Other counties are just as diverse as Pitt County. You should be aware of this if you request a county other than Pitt. All areas of counties are
used for placements.
We are dependent upon the willingness of NC public school teachers and principals to accept ECU students into their classrooms.
You should not contact a teacher directly to secure a placement. All placements must be made through the Office of Clinical
Experiences. No Wake or Moore County placements will be made unless the student resides or works in Wake or Moore County
as a Teacher Assistant. In addition all paperwork must be turned in to OCE by the individual county’s deadline in order to be
placed in Wake County or Moore County. No placements will be made in a private school, home school, or school with a
religious affiliation. No out-of-state placements will be made. No students will be placed with relatives adults or children.
All placements must be housed in a NC public school, approved NC public charter school, or NC agency that receives public
or state funding for public school children. This applies to all students including those enrolled in courses identified as distance
education (DE) and face-to-face (campus).
Give careful consideration to your request. Once assignments have been made, there will
be NO changes. Your request will be considered, but not guaranteed.
For consideration by the Office of Clinical Experiences, if you are taking another course(s) requiring a practicum, please check the appropriate box(es) and
indicate the section number. If known, please include the name(s) of the schools where you are placed for other practicums.
ELEM 2123 Section __________ School: _________________
ELEM 3235/36 Section __________ School: _________________
ELEM 3249 Section __________ School: _________________
ELEM 3250 Section _____________ School: _________________
ELEM 3275 Section __________ School: _________________
ELEM 4551 Section ______________ School: _________________
SCIE 3216
Section __________ School: _________________
MATE 3051 Section ______________ School: _________________
READ 3301 Section __________ School: _________________
READ 3302 Section: ______________ School: _________________
Other: _____________________________________________
Other: ___________________________________________________
Please read and complete the back of this form.
Please check any of the following that apply to you.
o I do not have transportation.
o I am a Senior I or Senior II. If so, list school, clinical teacher’s name and grade level:
_______________________________________________________
o I am a TA employed in a school. If so, list county, school and grade level employed:
________________________________________________________
o I am an ECU athlete. If so, list team and coach’s name:
________________________________________________________
Important Reminders to Students:
A. Students must adhere to East Carolina University’s dress code at all times when in a school. The
dress code will be sent to your instructor along with your placement and is posted on ECU’s
website.
B. Every effort will be made to meet your county and/or school request but it is not a guarantee.
C. You are responsible for transportation to and from your assigned practicum site.
D. You are responsible for making contact with the practicum teacher and establishing a schedule of
observation within two weeks of receiving your placement from the Office of Clinical Experiences,
the sooner the better.
E. If a problem arises you should contact your course instructor immediately.
F. If you have any charges pending or resolved you must disclose them to the Office of Clinical
Experiences.
G. Students must wear identification, either driver’s licenses or 1 Card ID, using the badges provided
to you in your early experience class.
H. Students with a documented disability that requires accommodations within their placement need
to notify Liz Johnson in the Office of Disability Support Services at johnstonl@ecu.edu and ask her
to contact Susan Morgan at morgans@ecu.edu.
I. Remember you are a guest in the school. You represent ECU and yourself at all times. Always
exhibit professionalism.
J. Students must adhere to all due dates for practicum placements.
K. The last day for practicum work in any school is November 15th in fall and April 11th in the spring.
Please sign below verifying you have read the entire practicum placement request form.
Student Signature ____________________________________________________________
Instructor: Please sign below verifying you concur with the student’s assignment request.
Instructor Signature ___________________________________________________________