Fillable INTERVIEW VERIFICATION PRE-TEACHER CANDIDACY CLINICAL EXPERIENCE (Wisconsin Lutheran College)

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INTERVIEW VERIFICATION PRE-TEACHER CANDIDACY CLINICAL EXPERIENCE (Wisconsin Lutheran College)

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INT #1
Student Name: _______________________________________________________________________
last first middle
EDU Course No.: ________________________ Course Title: __________________________________
Date of Interview: _________________________ Date Report Completed: _______________________
mo da yr mo da yr
(report on the interview should be completed one week after the interview)
Educational position interviewed: _________________________________________________________
Name of person being interviewed: _______________________________________________________
School: ______________________________________________________ District: ________________
_________________________________________
signature of person interviewed
_________________________________________
signature of student interviewer
_________________________________________
signature of EDU Professor date
_____________ __________________________
hours credited director initials
DIRECTIONS: Complete one form for each interview requirement. No interview may count for two requirements. Summarize
the contents of the interview and write a reflection on that information obtained. Submit this summarization/reflection in a
TYPED format on the back of this sheet or on an attached sheet. (It is recommended that you copy this form and your response
for your own files before you submit this to your EDU professor.)
12/09
INTERVIEW VERIFICATION
PRE-TEACHER CANDIDACY CLINICAL EXPERIENCE
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INTERVIEW VERIFICATION PRE-TEACHER CANDIDACY CLINICAL EXPERIENCE (Wisconsin Lutheran College)

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Completed 21 July 2020

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