1.

DECLARATION FORM

This is a COMPULSORY document for TPS3704.

The purpose of this declaration form is to ensure the authenticity of this portfolio and the
practical teaching it was based upon. Please complete and sign this declaration form. The
mentor teacher and the school principal should also sign it.

DECLARATION BY STUDENT:

I, ............................................................................................... (Name), student number ________________

declare that all the work in this portfolio is my own and that I completed 25 days of practical teaching.

Signature ………………………………………………………..
Date:……………………………………………………

DECLARATION BY MENTOR TEACHER:

I, ....................................................................................... (Name), declare that the abovementioned

student completed her/his 25 days of practical teaching under my supervision or that of my
colleagues.

Signature …………………………………………………………
Date ………………………………………..

DECLARATION BY SCHOOL PRINCIPAL:

I, ..................................................................................(Name), declare that this student completed 25

full school days of supervised practical teaching at
… ........................................................................................ (Name of institution).

Signature ……………………………………………………..
Date ………………………………………………………..

OFFICIAL SCHOOL
STAMP

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 3. MENTOR PAGE

MENTOR REPORT REGARDING (name of student)

BY TITLE: ................ SURNAME: ................................................ NAME: ...............................................

CONTACT DETAILS (those of the school if that is what you prefer):

Cell phone: ............................................ E- mail: .....................................................................................

Name: ………………………………………………………………….……….……………………..
Qualifications: ……………………………………………………………….……………………..
Experience as teacher: ……………………………………………………….……………………..
Experience as mentor (how many students mentored before?): ……………………………..
Training as mentor (by whom and how much/ formal/informal, accredited or not)
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

Please provide fair and honest comments regarding the following:

Was the general conduct of the student irreproachable (on time, conduct according to school
requirements for teachers)?

....................................................................................................................................................................

....................................................................................................................................................................
Was the level of subject knowledge of the student sufficient for the presentation of lessons?

....................................................................................................................................................................

....................................................................................................................................................................
Did the student make use of your suggestions and recommendations to improve her/his work?

....................................................................................................................................................................

....................................................................................................................................................................

Did the student prepare well when she/he had to present lessons?

....................................................................................................................................................................

....................................................................................................................................................................
Did the student work regularly/ continuously on her/his portfolio?

....................................................................................................................................................................

....................................................................................................................................................................

13
 TPS3704/103/2024

Did the student complete her/his portfolio during the Practical Teaching period? YES/NO
Strong points of the student/ good qualities and good work done:
....................................................................................................................................................................

....................................................................................................................................................................

Aspects on which student still have to improve to be ready to enter education as a beginner
teacher:

....................................................................................................................................................................

....................................................................................................................................................................

SIGNATURE SCHOOL STAMP

Date: ____________________________

14
Observations/comments/suggestions:

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………

Mentor teacher’s signature: NB: SCHOOL STAMP

………………………….......................

Your Signature: …………………………………………….

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18 ATTENDANCE REGISTER OF STUDENT TEACHER AT SCHOOL
Please note that this register should be completed on a daily basis by the student and the school-based mentor. The
principal is expected to sign this register at the end of the Teaching Practice period and the register must be
submitted, by the student, to the Teaching Practice Office.

Student number:…………………………………………………………………………………………………………………………………

Name of school:………………………………………………………………………………………………………..……..…………………

Address:………………………………………………………..…………………..……………………………………………………………..

Contact details:…………………………………………………………………………………………………………………………..….……

E-mail:……………………………………………………………………………………..…………..………………………….………………

Name and surname of mentor:…………………………………………………………………………………………..……………..……..

Name and surname of principal/HOD:……………………………………………………………………………………..…………………

Week 1

Student number Module Grade Student Date Signature of mentor Date

signature

Week 2

Student number Module Grade Student Date Signature of mentor Date

signature

Week 3

Student number Module Grade Student Date Signature of mentor Date

signature

62
 TPS3704/103/2024

Week 4

Student number Module Grade Student Date Signature of mentor Date

signature

Week 5
Student number Module Grade Student Date Signature of mentor Date
signature

Declaration by the school principal/HOD

I, ……………………………………………, the Principal/Head of Department of the above

school confirm that

… ......................................... has attended/did not attend his/her full Teaching Practice period.

Date

………………………………

Signature

………………………………

School stamp

63