Appendix A: Site Feedback Form Complete 6 Times

DEPARTMENT OF ELEMENTARY AND EARLY CHILDHOOD EDUCATION

BRIDGEWATER STATE UNIVERSITY

ECPK 420 — Mentored Program Observation, Birth-K

Feedback on BSU Student Observations

Thank you for allowing a student from the BSU Early Education and Care program to observe your setting in action.  Your participation is vital to our students as they familiarize themselves with a wide range of preschool and kindergarten program models.

Your feedback on how our students conducted themselves in your settings is important to us.  Although our students are not placed in your settings as “teachers,” it is important to us that they demonstrate professional attitudes and behaviors in centers and school settings at all times.  Your signature on this form verifies the date and hours the student was in your setting.  These forms are stored separately from any written work the students submit describing their observations.

Name of student observer ________________________

Age(s) of children served________

Center or School ______________________________

Town _____________________

Program Type ________________________________

Date(s) & Time(s) ____________

Professionalism in scheduling appointment

[  ] satisfactory    [  ] reason for concern

comments

Professionalism of appearance and manner

[  ] satisfactory    [  ] reason for concern

comments

Professionalism while observing children and program

[  ] satisfactory    [  ] reason for concern

comments

Professionalism of communications with staff

[  ] satisfactory    [  ] reason for concern

comments

“I would be willing to have other BSU students visit my program.”

[  ] Yes                     [  ] No

comments

Other comments, concerns, or suggestions?  Please use the back of this form.

Name of Program Administrator and/or Teacher (PRINTED)

Signature of Program Administrator and/or Teacher

Position

Date

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