The Richard Stockton College of New Jersey
SCHOOL OF EDUCATION
Phone (609) 652-4688 Fax (609) 748-5528
Please Check One:
❒ Introductory Fieldwork
❒ Intermediate Fieldwork
❒ Ed. Psych. Fieldwork
Fieldwork Placement Form
Please type or print all information
Term: (circle)
Spring
Summer
Fall
E-Mail Address: __________________________________
Name:
(If not living at home, complete college address/phone below)
Permanent Address:
College Address/P.O. Box
City, State, Zip:
College Phone:
Phone
Major __________________________________________
Z# _____________________________________________
Please circle your fieldwork preference:
Elementary:
1ST
K
2ND
Middle School Content Area: ( 6-8 )
Secondary: ( 9-12 ) Art
English
Biological Science
Physics
Physical Science
3RD
4TH
5TH
Mathematics
Science
Chemistry
Earth Science
Spanish
Social Studies
English
Social Studies
French
Latin
Mathematics
Request for Sites: Please list your first, second, and third choice for fieldwork placement from the lists of schools on the back of this form. Do not list
schools in which you have had personal or professional relationships (the school from which you have graduated, schools where family members are
currently attending, schools in which you have completed fieldwork, substituted, etc.) Each elementary and secondary student must have at least one middle
school fieldwork experience. Please Note: While students may request possible placement sites, the School of Education makes all placements. Placements
cannot be changed once they are made by the school district. Students are not to contact districts, schools or teachers directly until they have received official
notification from the School of Education.
** You should select a school district from each placement group ( urban, rural, suburban ) that you have not been previously placed in so that
you have a diversified fieldwork learning experience.
** Placements are limited by the school district. If you do not get your first choice, we will try to place you in your second choice then third choice.
** From which high school did you graduate?_________________________________
Name of School District
Type of School Placement
Elementary – (At least one middle school experience)
Secondary – ( At least one middle school experience)
Grade Level
1st choice ______________________________
____________________________________
__________
2nd choice _______________________________
____________________________________
__________
3rd choice _______________________________
____________________________________
__________
Previous Placements: List previous school placements and substitute teaching experiences (list the school district):
Educational Psychology:
Intro Fieldwork:
Substitute/other Experience:
Once you receive confirmation of your placement,
it is your responsibility to contact the school and your cooperating teacher!
Signature
Date