August 26, 2016

Fall 2016 Clinical Experience Waiver

Intern Name: Francisco Alonzo
This is a waiver for one full day of clinical experience, a total of six (6)
hours for the week of August 29th September 2nd, 2016.
Directions:
1. Print this waiver and staple it to the back of your Timecard for your
records. On your Timecard, write in 1 day (toward your required days)
which is equivalent to 6 hours (toward your required hours) for this
particular week.
2. Once you have a confirmed internship assignment, show the copy of this
waiver to both your Intern Mentor Teacher and your Clinical Experience
Instructor so they are aware of this waiver and the hours/day you have
documented on your timecard, per my directions.
3. Explain to your Intern Mentor Teacher that he/she is to accept and signoff on this waiver for 1 day/6 hours on your Timecard and to include this
1 day/6 hours in your Tk20 midterm and final evaluation documentation
of hours/days.

Best,
Melissa Johnson
Placement Specialist

8/26/16