DEPARTMENT OF EDUCATION
IMMACULATA UNIVERSITY
IMMACULATA, PA 19345
PRE-STUDENT TEACHING VOLUNTEER HOURS

Name:
Class:
Field of Concentration:
Certification Program:  
ECE:
ELEM:
ELEM/SPEC:
SEC:
Experience involved:
Person in charge:  
Address:  
Participation:  
Number of times:  
Total number of hours:
Description of activities completed:  
Your role:  
Reflections about the experience:  

Supervisor signature: __________________________________________________

Student signature: ____________________________________________________

Date:

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