EDP 351 OBSERVATION VERIFICATION

To the teacher: Your signature verifies only that the identified student observed in your classroom on the specified date (s). You are not required to evaluate this student.

Student's name:_____________________________________________

Teacher's name: ____________________________________________

School: ___________________________________________________

School telephone number: ____________________________________

Date and time of visit: _______________________________________

Teacher's signature: _________________________________________

______________________________________________________________________________

Student's name:_____________________________________________

Teacher's name: ____________________________________________

School: ___________________________________________________

School telephone number: ____________________________________

Date and time of visit: _______________________________________

Teacher's signature: _________________________________________