DIRECTIONS: You must summarize and reflect on the data from your Contextual Data Form on the sheet that follows on the next page. Write a teaching and learning statement containing implications for lesson plan and unit development based on the data you collected. The completed Contextual Data Form and the Contextual Teaching and Learning Statement are included in this task.
Field Experience/Clinical Practice Form
This template is to be used in individual, stand-alone lesson or in your unit development.
PLACEMENT: Provide the information requested below.
LWC Student:______Term and Year: ______School: _____ District: _____
Cooperating/Mentoring Teacher: ______Principal: ______
Guidance Counselor: ______LWC Professor: ______
CLASS DESCRIPTION/ DIVERSITY DATA: Provide the information requested below.
Grade Level(s): ______; Ages: ______; Number of students: _____ ; Language(s): ______, ______; Gender: # Male: ___ # Female: ____; Ethnic/Cultural: ______, ______;
Number of students identified as ESL: ______* Number of students with IEP’S: ______;
Number of Title I students: ______; Number of students who are unusually demanding: ______;
Students not identified in other categories: ______;
( Length of this Class Period: ______; Length of Instructional Day: ______.
*Specific students are not to be identified.
RESOURCES AVAILABLE: Describe the resources (equipment, technology, supplies, etc.) available.
Technology: ______Books :______Supplies: ______Equipment: ______
ASSISTANCE: Place a (X) beside the phrase that describes the types of help available to you.
______instructional assistant(s) ______parent volunteers ______peer (student) tutors
______resource teachers ______classroom teacher ______other (Please specify)
PATTERNS OF ACHIEVEMENT: Indicate the number of students for each pattern of achievement.
_____ Below grade level _____ At grade level _____ Above grade level
OTHER CLASSROOM CONDITIONS: Describe other classroom conditions(if any) including student demographics that have
Implications for teaching and what might be observed in your classroom.
______ (Teacher signature and date)
Revised 7/8/2011
Unit Fall 2011 LWC Division Education