VERIFICATION OF PLACEMENT – ,

Instructions: Complete this form and mail to your university supervisor, Department of Agricultural Leadership, Education, and Communication, 110 Four Towers, University of Georgia, Athens, GA 30602, no later than the first week of student teaching.

Name of Student Teacher:     Justin Shealey      

Address during Internship:     2294 Register Rd Adel Ga.      

Phone Number:     229-356-0995         Email:       justin1@uga.edu     

(Note: List the teacher’s name as it should appear on official documents. If more than one cooperating teacher, list the one who has the greatest supervisory role.)

Cooperating Teacher:     Ben Tucker      

School:     Cook County Extension     Principal's Name:     N/A      

School Address:     206 E Ninth street      

School Phone #:     Co. Teach Home Phone #:

Coop. Teacher Email:           

DAILY SCHEDULE

Period No.

Time of Class

Course Title

Grade Level

Starting Date

Ending Date

Dates that you will not be in class (i.e., Spring Break, holidays, fair dates, CDEs, testing dates, etc.):

Not been determined

Directions to School:

I-75 South Bound get off on exit 39 and take left. take right on US 41. go through second red light start looking for Holiday Market on left take next road on left E Ninth Street