ECDE Practicum Placement Request Form
Complete all sections of this form and return it ASAP to Angie May-Brewer, or email it to amaybrew@cscc.edu
. This form will be used to place you at the most convenient location available. Without a submitted form, you will be placed randomly at an available practicum site location.
Name
Address you want considered for placement*
City/Zip Code
Phone
Cougar ID
CSCC Student Email
*If you want a placement close to home, list your home address; or if close to work, then list your work address
Practicum you are taking next semester:
__ Practicum 3
__ Practicum 1 Infant/Toddler __ Practicum 2 Preschool
---- Preschool
---- Administration*
---- Community Settings*
*Administration or Community Settings placements require an application and acceptance for placement consideration
Days and hours at your practicum placement site: To meet the ECDE program’s criteria for the 105 practicum hours per semester:

During Autumn and Spring semesters you will need to be at your practicum site two mornings a week for 3 to 4 hour increments each day (e.g. a 3.5 hour day would be similar to 8:30am-12:00pm) for a total of 7 hours a week through the 15 th week of the semester.

During Summer semester you will need to be at your practicum site two mornings a week for 4.5 to 6 hour increments each day (e.g. a 4.5 hour day would be similar to 7:30am-12:00pm or 8:00am - 12:30pm, and a 6 hour day would be similar to 7:00am - 1:00pm), ~OR~ 3 mornings a week for 3 to 4 hour increments each day for a total of 10.5 hours a week through the 10 th week of the semester.

You must schedule your days and hours at times when your mentor teacher is typically in the classroom

You must be with the same group of children for all of your practicum hours

Practicum hours cannot be scheduled during children’s napping hours (students can stay until 12:30pm or 1:00pm to help assist children with the transition into nap time, but cannot stay past 1:00pm as napping hours do not count as practicum hours)
1.) If you have completed a practicum, where were you placed for:
ECDE 2910 Practicum 1: ___________________________________________________________________________
(name of practicum site)
ECDE 2920 Practicum 2: ___________________________________________________________________________
(name of practicum site)
2.) Are you currently employed in a child care center? ____ yes ____ no
If yes, name of the center: _________________________________________________________________________
3.) Do you have a practicum site you would like considered for placement? (see the list of contracted practicum sites on the
ECDE Student Community under the Practicum tab).
*Every effort will be made to accommodate your placement request, HOWEVER, there cannot be a guarantee that your request can/will be accommodated!
________________________________________________________________________________________________________
(Form revised AU14)