FIELD OBSERVATION PLANNING and APPROVAL FORM

FIELD OBSERVATION PLANNING and APPROVAL FORM

CANDIDATE: E-mail:

TELEPHONE: Work Home Cell

COHORT/MODEL: LOCATION:[ ]North[ ]Central [ ]South [ ]

E-MENTOR: FIELD SUPERVISOR:

Directions

Candidates should complete this Planning and Approval form based upon professional growth targets and the application of school leader standards, discuss it with theirField Supervisor and then give the signed document to their E-Mentor.E-Mentors should record the approval in the NJ EXCEL online records section and note its completion on the candidate'sQuarterly Status Review. The candidate is responsible to attach a copy of the completed Planning and Approval Form on their Chalk and Wire Field Observation portfolio pageas documentation once they have received all approvals.

I.EXPECTATIONS

(Briefly describe your expectations for the Field Observation related to your personal, professional, and leadership development, andthe opportunity it provides for you to demonstrate your leadership knowledge and skills, and your ability to effectively apply district/school leadership practices)

II. BACKGROUND and CONTEXT

(Briefly describe the context in which you plan to complete your Field Observation, e.g. type of district, district-wide, department-based, or school-based, type of school, grade levels)

III. PROJECTED TIMEFRAME FOR FIELD OBSERVATION

A.Target date when Field Observation may be scheduled. ______

Based on the activity(ies) you are planning, identify time(s) of day when Field Observation may be scheduled. [ ] Morning [ ] Afternoon [ ] Evening

If you have identified a specific date and time for your Field Observation, please indicate:

Date:______Time:______

Additional Information:

IV. LOCATION FOR FIELD OBSERVATION

Where will your Field Observation be held?

[ ] My district/school[ ] A school in my district [ ] My Internship site

Site Address: ______

Site Telephone: ______

V.PLANNED FIELD OBSERVATION ACTIVITY(IES)

(Briefly describe the activity(ies) that you would like your Field Supervisor to observe.)

VI.APLICATION OF SCHOOL LEADER STANDARDS

(Briefly describe how the activities that you are planningfor your Field Observation will demonstrate your ability to apply school leadership practices in one or more of the following leadership areas. NOTE: Refer to the NJ EXCEL Candidate Performance Standards, Assessment Criteria and Rubrics.)

Personal Dispositions and Emotional Intelligence Competencies

School Leadership Area I -- Organizational Leadership (Reference Standards #1 and #2)

School Leadership Area II -- Instructional Leadership (Reference Standard #3)

School Leadership Area III -- Community Leadership (Reference Standards #4 and #5)

School Leadership Area IV -- Strategic Management (Reference Standards #6)

V.APPROVAL BY FIELD SUPERVISOR/REVIEWED BY E-MENTOR

(Discuss your plan and other considerations or extenuating circumstances with your Field Supervisor, and obtain his/her approval before scheduling your Field Observation. Provide a copy to your E-Mentor for Quarterly Status Review.)

Approval to Schedule Field Observation

Field Supervisor Signature: ______Date: ______

Comments:

REVIEWED BY E-MENTOR FOR QUATERLY STATUS REVIEW

E-Mentor Signature:______Date: ______

Comments: