Evaluation Form
Evaluation Type:
Midpoint
Summative
Evaluator:
University Supervisor
Cooperating Teacher
Evaluator's e-mail:
Student Teacher's Name: First:
Last:
Student Teacher's e-mail:
Cooperating Teacher : First:
Last:
Supervisor : First:
Last:
School:
District:
Grade Level:
Select One
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
Subject:
Program:
Select One
Accelerate Online
Post-bacc
Traditional
Date:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2008
2009
Domain I: Student Participation in the Learning Process
STUDENTS:
1. Are actively engaged and successful in learning.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Demonstrate critical thinking and problem-solving.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Connect learning to life applications.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain II: Learner-Centered Instruction
A. PLANNING AND PREPARATION
1. Exhibits knowledge of subject matter.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Aligns instructional strategies with lesson objectives.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Integrates content effectively.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Plans for differences in learner(s) needs and abilities.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Demonstrates resourcefulness and creativity.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
6. Uses a variety of instructional materials.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
7. Provides organized and accessible materials.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain II: Learner-Centered Instruction
B. INSTRUCTIONAL SKILLS—PROCEDURAL
1. Starts class promptly with little confusion.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. States purpose, objectives, and procedures for lessons.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Maintains lesson pace.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Gives procedural and instructional directions clearly.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Uses appropriate transitional techniques.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
6. Adapts to student attention span.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain II: Learner-Centered Instruction
C. INSTRUCTIONAL SKILLS—TEACHING STRATEGIES
1. Focuses student attention by motivational techniques.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Relates lesson to prior knowledge and life experiences.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Presents lessons in an organized manner.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Models lesson expectations.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Uses questioning strategies for higher-level thinking.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
6. Uses cooperative learning regularly and effectively.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
7. Engages students in inquiry techniques.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
8. Uses available technology effectively.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
9. Uses manipulative materials appropriately.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
10. Uses techniques that modify and extend student learning.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
11. Engages students in lesson closure.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain III: Evaluation and Feedback
A. STUDENT EVALUATION
1. Monitors students’ participation and progress.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Provides immediate and constructive feedback.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Bases evaluation on instructional goals/objectives.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Uses formal and informal assessment strategies.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Encourages student self-evaluation.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
6. Provides opportunities for re-teaching and enrichment.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
7. Provides evidence of student achievement.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain III: Evaluation and Feedback
B. SELF-EVALUATION
1. Uses reflective thinking to analyze instruction.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Recognizes need for improvement and implements change.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain IV: Management of Student Discipline, Instructional Strategies, Time and Materials
A. PREVENTIVE MAINTENANCE AND ORGANIZATION
1. Is aware of total teaching situation.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Establishes clear rules and procedures.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Anticipates problems and plans prevention.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Maximizes student time on task.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Manages classroom routines effectively.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
6. Uses classroom arrangement to enhance learning.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain IV: Management of Student Discipline, Instructional Strategies, Time and Materials
B. SUPPORTIVE MANAGEMENT TECHNIQUES
1. Encourages self-discipline.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Respects diversity among students.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Teaches students to exhibit respect for others.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Establishes risk-free environment.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Maintains positive rapport with students.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
6. Seeks to know each student as an individual.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
7. Reinforces appropriate behavior through encouragement.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain IV: Management of Student Discipline, Instructional Strategies, Time and Materials
C. CORRECTIVE MANAGEMENT TECHNIQUES
1. Exhibits a balance of fairness and firmness.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Enforces rules consistently and fairly.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Redirects inappropriate behavior promptly.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Shows disapproval of behavior but acceptance of student.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Remains calm in dealing with conflict and disagreement.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain V: Professional Competencies
A. COMMUNICATION
1. States academic and behavioral expectations.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Communicates on students’ level of understanding.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Listens with empathy and respect for others.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Demonstrates enthusiasm for students and subject matter.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Incorporates students’ opinions and ideas.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
6. Uses effective verbal and nonverbal communication.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
7. Uses appropriate and accurate oral and written communication.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
8. Projects voice appropriately.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
9. Avoids overused phrases (OK, Shhh, You know).
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain V: Professional Competencies
B. RELATIONSHIPS
1. Is dependable.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Displays courtesy and respect.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Is receptive to suggestions.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Adapts in a flexible manner.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Maintains a sufficient level of energy.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
6. Is discreet with confidential information.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain V: Professional Competencies
C. RESPONSIBILITIES
1. Abides by school operation schedule.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Meets responsibilities promptly.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Takes initiative in performing tasks.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
4. Maintains professional dress and behavior.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
5. Attends seminars and school related meetings.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain VI: Professional Development
1. Engages in professional development activities.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Works cooperatively with teachers, staff and supervisor.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
3. Exhibits dispositions condusive to professionalism.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
Domain VII: Compliance with Requirements
1. Shows respect for others.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
2. Creates a safe and orderly learning environment.
Rating: Select One
4 = Exceeds expectations
3 = Proficient
2 = Growth in progress
1 = Needs significant improvement
N/A = Not Applicable
N/O = Not Observed
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