CACHE Level 3

Early Years Educator

Placement Supervision Agreement

Learner No. Learner Name

In order to complete this course you will need access to the following age ranges which may
require more than one placement or setting.
Age Range Hours
0-1 year 11 months 25
2-2 years 11 months 133
3-5 years 192
Please complete the information for each of your placements. You may not need to
complete all of these this will depend on how many settings you are attending to complete
the required hours of the course across the age ranges.

Placement No 1:

Date of placement commencement: D D / M M / Y Y

Organisation:

Address/email address

Age Range Which days of the week

This form indicates that you have been informed of the placement supervision requirements
of the course, and that you consent to provide work experience support and supervision for
the above-named learner. (Placement supervisors are required to supply their certificates
and attach an up-to-date CV with this form). We cannot begin to assess work until this is
in place.

Mentor (please print name) and

EYE Placement Agreement Feb 2016 Page 1 of 4

 provide a handwritten signature

Job description (to be written in

the box or recorded as a voice
recording

Placement No 2:

Date of placement commencement: D D / M M / Y Y

Organisation:

Address:

Age Range Which days of the week

EYE Placement Agreement Feb 2016 Page 2 of 4

 Mentor (please print name) and
provide a handwritten signature

Job description (to be written in

the box or recorded as a voice
recording

Placement No 3:

Date of placement commencement: D D / M M / Y Y

Organisation:

Address:

Age Range Which days of the week

EYE Placement Agreement Feb 2016 Page 3 of 4

 Mentor (please print name) and
provide a handwritten signature

Job description (to be written in

the box or recorded as a voice
recording

Upon completion, upload to the portfolio system via the ‘optional evidence upload’ button,
or send to: Stonebridge Associated Colleges, Stonebridge House, Ocean View Road Bude,
Cornwall, EX23 8ST, United Kingdom

EYE Placement Agreement Feb 2016 Page 4 of 4