Field Experience Request Submission Instructions

  1. Field Experience Request forms revised JULY 2017 are the ONLY forms that will be accepted.  Please discard any old forms you may have saved on your computer.
  2. Instructor completes the Field Experience Request (PDF) or Field Experience Request (Word) form.
      1. Complete one form per class section, per school -
      2. Only one form is allowed per each school where a field placement is being requested.
      3. Only one form is allowed per class section. You cannot combine two class sections on one request form.
      4. Complete the entire form.  Incomplete forms will not be processed and will be returned for completion.  
      5. Rubric/Course title – list the course rubric and class name.
      6. Class day/time – list when the class meets on the school campus.
      7. Total number of candidates – list how many students are enrolled in the class.
      8. Suite Secretary – list your suite secretary’s name.
      9. Field Experience/Activities/Duties should describe what the student will be doing on the campus (i.e. “Observing one time, teaching four times, etc.”).
      10. School District must be listed.
      11. Campus name must be listed.
      12. Grade level – grade level at which the experience will take place.
      13. Dates of visits – dates on which the students will be on the school campus.  DO NOT WRITE “TBD”.  Request forms submitted without an approximate start date will be returned without being processed! 

        You must allow at least two weeks for the district to process the applications and background checks.

      14. Times of visits – Approximate times at which the students will be on the school campus.
      15. Number of students per visit – the number of students to be placed at the school listed.
      16. Employee information – any student employed with the district should be listed, including their position title and employee ID#, if applicable. NOTE: students employed with the district are still required to complete a background information form and undergo a criminal background check.
  3. Class roster
      1. ALWAYS ATTACH A ROSTER, regardless of the number of students going to the same school.
      2. Please have the roster printed in a large enough font to be easily read.
      3. If students listed on the roster are attending different districts or campuses, please mark the roster, indicating the students for which the request is being submitted.
  4. Program Verification Letter
    The Program Verification Letter (Sample), if required by the district, must contain the following information:
      1. On university/program letterhead
      2. Student’s name
      3. Semester and year
      4. Course name and number
      5. Instructor
      6. Instructor’s telephone number
      7. Instructor’s email
      8. District requested
      9. Campus requested
      10. Statement of need to complete observation hours or field experience
      11. Signed by instructor and dated
  5. Instructors observing students on a district campus may be required to sign in and present a driver’s license or state-issued ID.
  6. All forms must be completed in BLACK ink only.
  7. Students must successfully complete all district requirements for application and background checks before their field experience request will be considered by the district. 
  8. Keep copies of the Field Experience Request forms submitted. As the Instructor, you are to contact students when approvals have been obtained; make sure they know where to go, whom to contact, time to report and any other important information.
  9. NOTE: DO NOT retain a copy of any person’s criminal history form.  Doing so is both unacceptable and illegal.


  • College of Education

    Phone: 281-283-3600

    Bayou Building 1237
    2700 Bay Area Blvd, Box 517
    Houston, TX 77058-1002