7094EDN Casework Proposal

The information on this form constitutes an application for approval by the School of Education
and Professional Studies for Professional Practice arrangements related to the course
7094EDN, Building Social Emotional Competence in the Early Years.
Please email to Lecturer:____________________________
PERSONAL DETAILS:
Year:

Student Number:

Surname:

Given Names:

Contact Address:
Home Phone:

Mobile:

Email:
AGREEMENT WITH SETTING COORDINATOR/TEACHING STAFF:
Name
Position:

Contact Telephone:

Contact Address:
Address:

Mobile:

Approval to undertake casework in setting has been gained from coordinator

Setting description(a brief description only):

INFORMATION ON INDIVIDUAL CHILD: (casework for 7094EDN)

Age of child:
Please indicate identified SEL need according to Bentzen checklist (2009):
One area only
Initiation of activity

Attention span

Curiosity

Frustration tolerance

Relationship with teacher

Acceptance of routines and limits

Reactions to adults other than teacher

Interaction with other children

APPROVAL:
Casework described in this Application is
APPROVED / NOT APPROVED
7094EDN Course Lecturer:________________________Date:
(Signature)

/20

YES/NO