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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