Center for Urban Education Special Education Program Apprenticeship Experience Student Amber Chesney Assigned Mentor Sandy

Anderson

Apprenticeship Assignment (Year One) Creekside Elementary School Apprenticeship Assignment (Year Two) Creekside Elementary School Apprenticeship Assignment (Year Three) Creekside Elementary School Apprenticeship Assignment (Year Four) ountain !idge iddle School You may list additional Apprenticeship Assignments (e.g., Extended School Year) on the back of this form.

This form must be turned in at the end of each year. Please include a copy of this form in your portfolio. Colorado Disability Categories Grade Le el !ear "#$ %$ &$ '( Setting)
$%' $%' $%' $%'%' $%'%' $%'%' $%' $%' $%' $%' $%' Autism Spectrum "isorder Elementary iddle #igh $%&%'%( #earing )mpairment% including dea*ness Elementary iddle #igh $%& Serious Emotional "isability Elementary iddle #igh )ntellectual "isability Elementary iddle #igh $%&%'%( ultiple "isabilities Elementary iddle #igh $%'%( Orthopedic )mpairment Elementary iddle #igh $% ( Other #ealth )mpairment Elementary iddle #igh Speci*ic +earning "isability Elementary iddle #igh Speech or +anguage )mpairment Elementary iddle #igh $%&%'%( Traumatic ,rain )n-ury Elementary iddle #igh $ .isual )mpairment% including blindness Elementary iddle #igh $ "ea*/blindness Elementary iddle #igh $ 0reschooler with a "isability 1Setting Code2 $ 3 4eneral Education with Support5 & 3 !esource5 ' 3 Sel*/Contained5 ( 3 Other (please de*ine)

This *orm will be re6isited each year o* your program7