PRACTICUM SITE AGREEMENTS (MULTIPLE) PRACTICUM SITE STANDARDS SATISFYING AMS REQUIREMENTS. The Site Agreement is to be completed by the Head of School. It, along with required documentation, initiates arrangements for the practicum. Practicum Site and Supervision Agreement Forms: Agreements must be received and accepted by the MECR Director before the start of the practicum.Name of School* School Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School Phone*School FaxWebsite, if any Name of Head of School* First Last Email for Head of School* AMS Membership: It is recommended that the practicum site is an AMS member school. Programs report practicum sites annually to AMS using the AMS Adult Learner Registration and Practicum Report Form. The AMS office will send non-AMS member practicum sites information on the benefits of becoming an AMS member school.AMS Membership LevelPlease select oneAccreditedFullAssociateSatelliteInitiateInternationalNoneAMS School Member # (if none, write NONE)* Please upload your recent membership form from AMSAccepted file types: pdf, jpg, Max. file size: 512 MB.Other School Accreditation(s). If not accredited, write "None".* Please affirm each of these standards. A comment box will appear for any item marked “NO”.Licensing - The site must meet all local and state regulations.* Yes No Please explain*School Policies - The school must communicate to the adult learner and the teacher education program, in writing, its administrative policies and guidelines relating to the adult learner, including a written non-discrimination policy for children and staff.* Yes No Please explain*Job Description/Contract: The site must provide a job description and a contract of agreement acceptable to the site, the adult learner, and the teacher education program. This job description or agreement should include the nature and type of remuneration given the adult learner, if any. The contract must be received by the MECR Director before the start of the practicum.* Yes No Please explain*Cooperation with the Teacher Education Program - The school agrees to cooperate with MECR in all matters related to the practicum. This includes opportunities to complete in-classroom practicum assignments, release time for attendance and travel to scheduled MECR seminars, release time to make required observation visits to other classrooms, arrangements for a MECR Field Consultant to observe and meet with the intern at least three times, and completion of two progress reports by the student’s supervisor at the school. The head of school agrees to notify the MECR Director promptly in writing if there are changes in the practicum site arrangements described in this form.* Yes No Please explain*Job Responsibilities: Adult learners in their practicum phase cannot be asked to provide service to the school other than that which would be found as the responsibility listed in the job description of any teacher/administrator during their practicum hours (i.e. janitorial services, before or after day care services, etc.). The Adult learner may be expected to help in maintaining cleanliness and order of classroom on a daily basis. Adult learners may provide additional services outside their practicum hours if agreed upon by both parties.* Yes No Please explain*Class Schedule - The schedule must permit daily uninterrupted work periods of at least 2 hrs.* Yes No Please explain.*Classroom Environment: The environment must be designed and equipped to meet the developmental needs of the children served. The classroom must include child-size furnishings and contain the full complement of Elementary Montessori materials appropriate to the ages and needs of the children. They must be arranged on open shelves accessible to all children. AMS recommended materials lists for schools are available in the Handbook.* Yes No Please explain*Field Consultant - A MECR Field Consultant is allowed to make at least three visits to support and mentor the student, and to evaluate progress.* Yes No Please explain*How many interns are you enrolling under this Site Agreement?*12345678910 Name of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2 1/2 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Generally the student teacher works as a classroom assistant and is supervised by a qualified Supervising Teacher in the same classroom. A copy of the Supervising Teacher’s Montessori diploma and resume must be on file at MECR. In a Self-Directed Practicum, the student teacher leads the class and is supervised by the head of school or a qualified staff member designated by the head of school. A MECR Field Consultant makes at least three visits to support and mentor the intern and to evaluate progress. A Self Directed intern receives two additional consultations.There should be at least two adults with the group of children at all times. (i.e. lead teacher and assistant). Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Second MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2&fract12 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Third MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2&fract12 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Fourth MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2&fract12 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Fifth MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2&fract12 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Sixth MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2&fract12 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Seventh MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2&fract12 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Eighth MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2&fract12 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Ninth MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsToddler 18 months - 2&fract12 yearsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. Tenth MECR Intern for AssessmentName of MECR Intern* First Last Level*Infant/ToddlerEarly ChildhoodElementaryAdministratorNumber of Children in Class* Age Range At Start of Year: Age Range of Class: Infant 0-18 months, Toddler 18 months - 21/2 years, Elementary I 6-9, Elementary II 9-12 Note: Only students who enroll in the full EI-II program may do a practicum in an EII level classroom.*Please Select OneInfant 0-18 monthsEarly Childhood 3-6 yearsElementary I 6-9 yearsElementary II 9-12 yearsOtherOther Age Range (please specify)* Do you know the name of the other adult working in the classroom?*Please Select OneYesNo, as that person has not yet been determinedThere is no other adult in the classroomName of other adult working in classroom.* First Last Other adult's title* (ADDITIONAL) Name of other adult working in classroom First Last (ADDITIONAL) Title of other adult working in classroom Start Date* MM slash DD slash YYYY Completion Date* MM slash DD slash YYYY Daily Hours (i.e. 7:30AM to 12:00PM) Minimum hours I/T and EC: 4 hours per day, 9-month school year. Minimum hours E-I and E-II: 6 hours per day, 9-month school year. By submitting this completed document I certify that all provided information is true and that I support the MECR requirements for the intern. I understand that the MECR intern has given consent to MECR personnel to discuss my progress in the academic and practicum phases of the MECR course with my site supervisor. I confirm that the Head of School completed this form. Note: a confirmatory e-mail containing a copy of this agreement will be sent to the Intern and the Head of School.
