INTERNSHIP WEEKLY REPORT
TO DSU SUPERVISOR

Directions:  Fill out this form with your cooperating teacher on the next to the last school day of each week.  Mail or FAX the form to your DSU supervisor.  If the teaching schedule changes, let your supervisor know by phone or FAX.  

Name _____________________________ School _____________________________

School Phone ______________________ School Fax __________________________

DSU Supervisor ______________________________________________________

Date of Mailing _____________ Cooperating Teacher ________________________

Anticipated teaching activities:  Week of ______________ to __________________

Subject		Time		Room 		Teaching Days – place an “X”
							under the days you teach

							M	T	W	Th	F

__________   		_____		______	___	___	___	___	___

__________   		_____		______	___	___	___	___	___

__________   		_____		______	___	___	___	___	___

__________   		_____		______	___	___	___	___	___

__________   		_____		______	___	___	___	___	___

__________   		_____		______	___	___	___	___	___
 
__________   		_____		______	___	___	___	___	___

__________   		_____		______	___	___	___	___	___

__________   		_____		______	___	___	___	___	___

__________   		_____		______	___	___	___	___	___

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