HOST SCHOOL OR
ROLE IN PLACEMENT
Overall Outcome of Placement: Pass Fail
Number of Hours Completed: !
The TES student met the specific expectations agreed upon in advance of the
placement (on the original Placement Proposal Form).
The TES student demonstrated professionalism in interactions with key stakeholders
(such as children, parents, other members of the host organization, etc.)
The TES student demonstrated a commitment to education during this placement.
The TES student demonstrated initiative during this placement.
The TES student was responsive to constructive feedback with respect to learning how
to better meet the needs of the learning environment.
Host Professional Signature: _________________________________________ Date: _________________________
Please submit this form to the School of Education office
(in hard copy at OC 214.1or by email to email@example.com).
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