Child 16/116 Practicum

Activity Planning Form

Name:__________________________________ Date:___________________

Ages of Children:___________ Number of Children At One Time:_________________

Number of Adults Needed: ____________ Title: _______________________________

I. LEARNING OBJECTIVES:

II. MATERIALS AND SUPPLIES NEEDED:

III. PREPARATION:

IV. PROCEDURE:

V. REFERENCE:

______________________________

Supervising Teacher Signature