Bridgewater State University Children's Center

Request for Observation and Completion of Course Assignments

 

Thank you for your interest in the Children's Center! Part of our mission is to serve as a training site and research facility for Bridgewater State University faculty and students. We will try to accommodate the times you would like to visit the Center, but because our space is small, please understand that we must limit the number of adults present at any one time. Kindly complete and return this form and we will contact you as soon as possible to schedule a specific time for your visit(s).

 

Student's name ___________________________________ Date of request_________________

 

Telephone number __________________________E-mail address ________________________

 

Course name and number _________________________________________________________

 

Name of professor ______________________________________________________________

 

What is your assignment? ________________________________________________________

 

______________________________________________________________________________

 

Given that the Children's Center is open Mondays through Fridays from 7:30 a.m. until 5:30 p.m., please list all the dates and times you are available to visit (excluding rest period from 12:30 – 2 p.m.) _________________________________________________________________

 

______________________________________________________________________________

 

When is your assignment due? ____________________________________________________

 

What are you hoping to observe/learn from this assignment? _____________________________

 

______________________________________________________________________________

 

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Information below to be completed by Children's Center staff:

 

Name of cooperating Children's Center teacher: _______________________________________

 

_____ Shown location of Visitors' Log

 

_____ Given copy of Confidentiality Statement (in front pocket of Visitors' Log)

 

_____ Hours entered on Student Observation and Activities Calendar

 

_____ Instructed to wash hands thoroughly upon arrival

 

_____ Copy of form for director's files

 

Teacher's notes:

Last Modified: September 17, 2010