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Name of observer:
Date of request:
Course name (if applicable):
College/Department/Program or employer:
1. What is the purpose of this observation?
2. What observation / assessment instruments or materials will be used?
3. How have observers been prepared for this experience?
4. If you are a student, describe the course assignment or the degree requirement that this observation is fulfilling:
To help us schedule your participation, we need to know the following:
How many children do you need? __________________________
What ages? __________________________________________
How many hours will the observations take? _________________
What day and time would you like to come? __________________
Please include a copy of the following with this application:
- Resume or CV
- Letter of reference from sponsoring faculty member or employer
- Results of current TB test
- D.C. Criminal background check (If you work in a Early Childhood program in Maryland or VA, a copy of the one required for those jurisdictions will suffice.)
Submit this application to:
Jane Banister, Hoya Kids Learning Center, 3624 P. St. NW, Box 571219; Phone: 687-7667, Fax: 687-1192
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