UNIVERSITY OF SCRANTON
The University of Scranton
Education Department
Field Experience Placement Application
Name___________________________________ Status (Please circle one) Grad Undergrad
Address (local) _____________________________ (home) ______________________________
_____________________________ ______________________________ _____________________________ ______________________________
Telephone (local) ___________________________ (home) _____________________________
E-mail address _________________________ Credits to date ____ Credits current semester ____
Major ____________________________ Teaching area (if SEC ED) _______________________
This application is for (Please circle one) Field II Field III
Requesting placement for (Please circle one) Fall Intersession Spring Year 20_____
Do you have transportation? Yes No
High school attended (Only if local) _________________________________________________
On what complete mornings/afternoons are you available for field work? (Circle all that apply)
Monday a.m. Tues. a.m. Wed. a.m. Thurs. a.m. Fri. a.m.
Monday p.m. Tues. p.m. Wed. p.m. Thurs. p.m. Fri. p.m.
Complete below ONLY if applying for Field III:
Field II school placement assigned _________________________________ Grade level ____________
You must have up-to-date Act 34 and 151 clearances and a valid FBI fingerprint record in order to be given a field placement. Clearances can take up to six weeks to obtain, so plan ahead. They last for one year and must be valid at the period in time that you will start your field experience. You can access these forms by going to the links below:
Act 151
Act 34
FBI Print
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