Clinical Field Experience Verification Form

CLINICAL FIELD EXPERIENCE VERIFICATION FORM
CANDIDATE NAME
Nicole Jenkins STUDENT NUMBER 20660298
PROGRAM:
Bachelor of Science in Elementary Education
ESL-440N: Methods of Structured English Immersion for Elementary Education

COURSE:
START DATE: 3/8/2021 END DATE: 5/2/2021
Grand Canyon University

PRACTICUM/FIELD EXPERIENCE FACILITY NAME:
AZ
SCHOOL STATE:
Amy McDonnel
MENTOR NAME:
15.00
TOTAL PRACTICUM/FIELD EXPERIENCE HOURS REQUIRED:
15
TOTAL PRACTICUM/FIELD EXPERIENCE HOURS COMPLETED:
Clinical Field Experience Verification Form
CANDIDATE INFORMATION
Last Name Jenkins
First Name Nicole
Student Number 20660298
Candidate Program of Study

Bachelor of Science in Elementary Education
COURSE INFORMATION
Placement Course Title ESL-440N: Methods of Structured English Immersion for Elementary Education
FACILITY INFORMATION
Facility Name Grand Canyon University
Type of Facility Facility Setting

Other Urban
Other Facility
Address
3300 W Camelback Rd,
City Phoenix State AZ Zip Code 85017
Country
United States
SCHOOL INFORMATION
School Classification Private Title One (I) Yes
School District N/A
Principal/Administrator Name
N/A
Principal/Administrator Phone
N/A
Principal/Administrator Email
[email protected]
MENTOR INFORMATION This is the person directly supervising the practicum/field experience activities. Note: This is NOT the GCU
course instructor. Example: Teacher, Administrator, Director, etc.
Mentor Name Amy McDonnel
Mentor Mentor Phone Mentor Grade

Email [email protected] Number N/A Level K-3rd
Address *
*School/Work Email address required
PRACTICUM INFORMATION
Activities Please describe the activities completed (Independent Whole Group Instruction, Interview, Administrative Duties) e.g. Observation, Partner Teaching,
Grading, Independent Small Group Instruction,
I watched Videos as an alternative to get my 15 hours for my practicum class.
Date Practicum Activities Started 3/29/2021 Date Practicum Activities Ended 4/18/2021
Total Practicum Hours Completed By Candidate 15
Additional Information As Applicable
Did your experience include students in any of the following categories? Check all that apply:
English Language Learners (ELLs)

Students with Individualized Education Plans (IEPs)
Students with Behavioral/Cognitive Needs
Students with Section 504 Accommodations
Identified Gifted Students
✔ Other:
Online observations due to virus outbreak
AGREEMENT AND SIGNATURE

I, the above named, GCU student attest this submission is accurate, true and in compliance with GCU policy guidelines, to the best of my ability
to do so. NOTE: The data entered into this document may be audited for accuracy. Candidates who engage in fabricating, falsifying, forging,
altering, or inventing information regarding practicum/field experiences and/or the log may be subject to sanctions for violating GCU academic
integrity policies, which may include expulsion from GCU.
Candidate E-Signature Nicole Jenkins E-Signature Date 4/19/2021

To Be Completed by the Mentor
This is the person directly supervising the practicum/field experience activities. Note: This is NOT the GCU course instructor.
Example: Teacher, Administrator, Director, etc. Note: The data entered into this document will be viewed by both the candidate
and university.
Please enter the number of hours completed by the candidate: 15
Practicum/field experience covers a wide range of activities and require candidates to demonstrate skills and
dispositions. GCU values the dispositional development of its candidates and therefore asks you to provide
the candidate with feedback to help guide their dispositional development. For additional questions,
comments and/or concerns contact [email protected]
1 2 3 N/A
The disposition is not The disposition is sometimes The disposition is frequently Not applicable (There was not an
observed through the observed through the observed through the opportunity to demonstrate this
performance of the candidate. performance of the candidate. performance of the disposition and does not impact
candidate. the candidate’s overall rating)
High Expectations: Candidates should believe that all students could learn and should set and support realistic expectations for
student success. These expectations should be communicated in positive ways.
1 2 3 N/A
Fairness: Candidates should promote social justice and equity, maintain appropriate standards of confidentiality, and exercise fairness
in all areas including assessment.
1 2 3 N/A
Professional Conduct: Candidates should exercise sound judgment and ethical behavior. They should be a positive role model within
their community.
1 2 3 N/A
Reflection: Candidates should recognize that reflection combined with experience leads to growth as a professional. Educators should
be thoughtful about their professional practice, critically examine it, and seek continual improvement.
1 2 3 N/A
Curiosity: Candidates should promote and support curiosity and encourage active inquiry.
1 2 3 N/A
Honesty: Candidates should model integrity by their words and actions.
1 2 3 N/A
Compassion: Candidates should demonstrate professional friendliness, warmth, and genuine caring in their relationships with others
while providing intellectual and emotional support.
1 2 3 N/A
Advocacy: Candidates understand the impact of community involvement and servant leadership as it applies to the welfare of others
in the educational setting
1 2 3 N/A
Dedication: Candidates should be committed to the profession of teaching and learning.

1 2 3 N/A
Respect for the Diversity of Others: Candidates should be sensitive to individual learning and the social needs of students and
embrace the cultural diversity of the community. They should develop and maintain educational communities marked by respect
for others. They should interact with their students, fellow educators, administrators, parents and other community members
with courtesy and civility and establish relationships characterized by respect and rapport.
1 2 3 N/A
Can you verify the Candidate has participated in the activities as listed in the Practicum Information section on page 1?
Yes No
Has the Candidate demonstrated knowledge and/or ability in the role of a pre-service teacher?
Yes No
Mentor Comments:
Thank you for allowing our candidate to observe and/or participate in your facility. At the end of the practicum / field experience,
please evaluate this candidate. Write a brief narrative, in the space provided below, assessing the performance of the candidate in
the activities in which he / she was involved.
Nicole watched supplemental videos in lieu of hours in the placement setting as approved by the College of Education.
AGREEMENT AND SIGNATURE

I attest this submission is accurate, true and in compliance with GCU policy guidelines, to the best of my ability to do so.
Mentor E-Signature Amy L McDonnel

Amy L McDonnel (Apr 20, 2021 17:09 PDT)
E-Signature Date Apr 20, 2021

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ESL-440N: Methods of Structured English Immersion for Elementary Education

START DATE: 3/8/2021 END DATE: 5/2/2021

Grand Canyon University

First Name Nicole

Student Number 20660298

Candidate Program of Study

Type of Facility Facility Setting

City Phoenix State AZ Zip Code 85017

School District N/A

Mentor Name Amy McDonnel

Mentor Mentor Phone Mentor Grade

English Language Learners (ELLs)

AGREEMENT AND SIGNATURE

Candidate E-Signature Nicole Jenkins E-Signature Date 4/19/2021

Please enter the number of hours completed by the candidate: 15

Honesty: Candidates should model integrity by their words and actions.

Dedication: Candidates should be committed to the profession of teaching and learning.

AGREEMENT AND SIGNATURE

Mentor E-Signature Amy L McDonnel

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