HOST TEACHER/STUDENT OBSERVER
AGREEMENT/ATTENDANCE SHEET

Semester/Year _________________________________________________________________

Course Name/Number ___________________________________________________________

In accordance with the guidelines set by SUNY Orange, the following observation times have been agreed upon by both the Host Teacher and Student Observer:

Student Name         ______________________________________________________________

Student Cell/Email _______________________________________________________________

Observation Site	______________________________________________________________

Host Teacher	______________________________________________________________

This Agreement/Attendance Sheet is an official document of SUNY Orange. Sign, in ink, each time the student observes. Student must submit to his or her instructor at the end of observations. PLEASE round attendance to the nearest quarter hour.

Date
Times
In/Out
Total 
Hours
Teacher Signature
Student Signature
















































































Circle one (1) and check hours are met (another sheet may be needed for second placements):
Intro to Early	Social and		Observation and	Infant and Toddler	
Childhood		Philosophical	Assessment		Development
10 Hours		10 Hours		24 Hours		16 Hours
Revised 08/02/2012