Field Experience Data Collection Form

Instructions: Using the data you collected during a field experience, record the appropriate data from your experience on this form. The only optional item on this form is final item (reflection); all other items are required. Please ensure that your responses for each drop-down list do not change when you scroll down the page.

Enter your last name.
Enter your first name.
Enter your MSU ID (Banner Self-Service ID).
Enter your e-mail address (e.g., yourname@yourdomain.com).

Select your academic program.

Select the semester.

Enter the year.

Select the course ID.

Enter the course number.

Select the field experience level.

Enter the total number of FEMALE students in the setting.
Enter the total number of MALE students in the setting.

Select all ethnicities represented.
Select all grade levels represented.
Enter the duration in hours. Use .25, .5, and .75 to indicate 15-, 30-, and 45-minute intervals, respectively. Enter a zero for subjects not included in this field experience. Use numbers only--not text.

Art
Music
Business
English
Foreign Language
Health
Language Arts
Mathematics
Physical Education
Reading
Science
Social Studies
Special Education
Other

Select the type of class.

Select the type of school.

Select the parish.

Enter the site name.
Enter the last name(s) of the school-based supervising teacher(s).

Enter a summary of activities completed during this field experience. Note: This item is optional.

STOP!
Check all your responses, especially those in drop-down lists, to ensure that they are accurate. If you print a copy of this form, remember to click Submit AFTER your copy is printed.

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