Center for Urban Education

Special Education Program

Apprenticeship Experience

Student ______Michael Sykes_____________ Assigned Mentor ______________________Chris Callow________________

Apprenticeship Assignment (Year One)____________________________________________________________________________________
Apprenticeship Assignment (Year Two)____________________________________________________________________________________
Apprenticeship Assignment (Year Three)___________________________________________________________________________________
Apprenticeship Assignment (Year Four)____________________________________________________________________________________
(Please list additional Apprenticeship Assignments on the back of this form.)

This form must be turned in at the end of each year. Please include a copy of this form in your electronic portfolio.
Disability Labels: State Terms Grade Level Year (1, 2, 3, 4) Setting*
Autism Spectrum Disorder Elementary Middle High 2,3,4 1,2,3
Deaf-Blind Elementary Middle High
Hearing Disability Elementary Middle High 2,3,4 1,2,3
Multiple Disabilities with Cognitive
Impairment
Elementary Middle High
2,3,4 3
Physical Disability Elementary Middle High 2,3,4 1,2,3
Significant Identifiable Emotional
Disability (SIED)
Elementary Middle High
2,3,4 1,2,3
Significantly Limited Intellectual Capacity
(SLIC)
Elementary Middle High
2,3,4 3
Specific Learning Disability (SLD) Elementary Middle High 1,2,
Speech/Language Disability Elementary Middle High 2,3,4 2
Traumatic Brain Injury
(TBI)
Elementary Middle High
2,3,4 1,2,3
Vision Disability Elementary Middle High 2 3
Other Elementary Middle High
*Setting Code: 1 = General Education with Support; 2 = Resource; 3 = Self-Contained; 4 = Other (please define)


Appendix F