Miami University
APPLICATION FOR USE OF THE CENTER
Observation and/or Participation

I. To Be Completed By Supervisor/Professor Requesting Access:

Name of Supervisor Requesting Access: Date:

Address:

  

City, State:

  ,

Zip Code:

 

Email:

  

University or Organization:
WSU
UD
Sinclair
Miami
Other:

Quarter or Period of Time for which Access is Requested:
Fall
Winter
Spring
Summer

Course Name and Number:

Number of Students to be Placed:

Total Amount of Time each Student needs to Spend Participating and/or Observing:

NOTE: Faculty members needing to place students for quarterly participation experiences should contact the center Administrator at:

513-529-8383 (Miami)
937-775-4070 (Wright State University)
937-461-9027 (Montgomery County's Mini University)
937-224-3916 (Miami Valley Hospital)

Additional paperwork is required by the Ohio Department of Job and Family Services for this type of participation. You may fax your request to the appropriate center. Numbers listed at end of this page.

II. To Be Completed By Student:

Name: Date:
Phone Number:

Address:

  

City, State:

   ,

Zip Code:

  

Email:

  

Please check all applicable categories below:

I wish to observe and/or participate at

Miami (6 wks - 12yrs)
WSU (6 wks - 12 yrs)
MCMU (6 wks - 6 yrs)
MVH (6 wks - 6 yrs)

on:

1 occasion: (date): Time:

or:

for the period of: (date) to (date)
daily weekly bi-weekly monthly

on: Mon Tue Wed Thur Fri
from: 9-11 3-5 Other: (naptime is from 12-3 and is no observations are permitted, except for Infants)

IN-CLASS OBSERVATION: I wish to observe children of the following ages:
Infants, 6 wks-18 months (Not available at Miami)
Toddlers, 18-36 months
Preschool, 3-5 years
Kindergarten, 5-6 years
School Agers, 6-12 years (Not available at MVH; limited at MCMU)
OBSERVING FROM OBSERVATION ROOMS: (Available at the WSU-CDC and Miami only) I wish to observe children of the following ages:
Infants, 6 wks-18 months (WSU only)
Toddlers, 18-36 months
Preschool, 3-5 years
School Agers, 6-12 years

IN-CLASS PARTICIPATION: I wish to have contact with children in the classroom.

I need to interact with the children during on-going activities.
I need to take a role as a teacher during on-going activities.
I need to plan and carry out a classroom activity under the guidance of the classroom teacher or my supervisor.
Do you need any classroom materials?
No
Yes, please describe:

(Materials are made available when possible, however, the center is not responsible for providing any items.)

IMPORTANT INFORMATION:

  1. Before audio or video equipment is used, written permission must be obtained from the parent. 48 Hours Notice Required.
  2. A letter must be written by the student describing the project or activity to the parents. This needs to be on file at the center before the observation/participation begins.
  3. APPROPRIATE BEHAVIOR FOR ALL CLASSROOM ADULTS:
    1. Interact with children in a safe and nurturing way.
    2. Maintain confidentiality.
    3. Avoid using the word 'no' and other negative words. Tell children what they CAN do.
    4. Speak in low tones using an "inside" voice at eye level with the child.
    5. Avoid shouting across the room or playground to a child.
    6. Work as a team with other teachers in the classroom. (Children must always be in the presence of a Mini U staff member.)
    7. Wash your hands often. All staff must wash their hands when entering the classroom and at the following times:
      1. When hands are obviously soiled.
      2. After restroom breaks.
      3. Before preparing or serving food.
      4. Before feeding children.
      5. After wiping a nose.
      6. After diapering.
      7. After handling pets.
      8. After being on the playground.

Fax numbers:
Miami University CDC - 513-529-8388
Wright State University - 937-775-2832
Miami Valley Hospital CDC - 937-224-0230
Montgomery County CCC - 937-461-6967