Prairie View A&M University
Whitlowe R. Green College of Education
Clinical Teaching Record
Clinical Teacher:
Semester:
Year:
School Name:
School District:
Clinical teaching assignment #1 (grades/subject):
Clinical teaching assignment #2 (grades/subject):
Each clinical teacher is advised to keep a logbook summarizing his or her daily activities to assist
with the completion of this form. Guidelines of PVAMU and the state of Texas require a minimum
of 360 hours of clinical teaching experience including at least 65 hours in observation and
limited participation, at least 160 hours in preparation for actual teaching, and at least 145
hours in actual teaching. The candidate should also be involved in other activities related to
reaching such as faculty meetings, extracurricular activities, supervision of students, professional
development, etc. the candidate is required to complete this form reflecting the total number
of hours for each general area for each week of the clinical teaching experience.
HOURS OF EXPERIENCES PER WEEK
Week Number
Activity
1
2
3
4
5
6
7
8
9
10
11
Total
12
Observation
& Limited
Participation
Preparation
for Teaching
Teaching
Activities
Related to
Teaching
Total Hours
I certify that the information is correct:
Signature of Clinical Teacher
Date
Signature of Cooperating Teacher #1
Date
Signature of Cooperating Teacher #2
Date
13
14
15
16