• Student Name* First Last
• Grade / Subject Area:*
• School*
• Supervisor Name* First Last
• Supervisor's Email address*
• Position*
  Cooperating Teacher Clinical Supervisor Academic Supervisor
• Date of Evaluation* MM/DD/YYYY

• ________________________________________________________________________________________

• Your student teacher has now completed about one-half of his/her experience with you. Please evaluate his/her current status in the following areas by circling the appropriate level after each statement.

  Key:     1 – Below expectations     2 – Meets expectations     3 – Exceeds expectations  4 - Not observed
  

• ________________________________________________________________________________________

• Domain 1: Planning and Preparation 
  

• 1a. Demonstrates knowledge of content and pedagogy, including NYS and professional association standards. * 1 2 3
• 1b. Demonstrates knowledge of students’ learning styles, abilities and disabilities, interests, and cultural heritage.* 1 2 3
• 1c. Selects appropriate instructional goals that are clear, valuable, and suitable for diverse learners.* 1 2 3
• 1d. Demonstrates knowledge of resources, including technology and assistive technology. * 1 2 3
• 1e. Designs coherent and differentiated instruction, including learning activities, student grouping, and lesson structures that support instructional goals. * 1 2 3
• 1f. Assesses student learning in a manner congruent with instructional goals and standards. * 1 2 3
• Comments on Domain 1:

• ________________________________________________________________________________________

• Domain 2: The Classroom Environment
  

• 2a. Creates an environment that reflects the Franciscan values of genuine warmth, caring, empathy and mutual respect.* 1 2 3
• 2b. Establishes a culture for learning where content is valued and expectations for learning and achievement are high.* 1 2 3
• 2c. Manages classroom procedures (routines, duties, transitions, materials) and the work of volunteers and paraprofessionals.* 1 2 3
• 2d. Manages student behavior through clear expectations, monitoring of student behavior, and responses to student behavior.* 1 2 3
• 2e. Organizes physical space and resources in ways that promote safety and accessibility to learning.* 1 2 3
• Comments on Domain 2:

• ________________________________________________________________________________________

• Domain 3: Instruction 
  

• 3a. Communicates clearly and accurately via oral and written language.* 1 2 3
• 3b. Uses questioning and discussion techniques in which questions are of high quality and discussion techniques promote student participation.* 1 2 3
• 3c. Engages students in learning through content, activities, assignments, student grouping, materials, resources, structure, and pacing.* 1 2 3
• 3d. Provides feedback to students that is accurate, substantive, constructive, specific, and timely.* 1 2 3
• 3e. Demonstrates flexibility and responsiveness through lesson adjustment, responsiveness to students, and persistence.* 1 2 3
• Comments on Domain 3:

• ________________________________________________________________________________________

• Domain 4: Professional Responsibilities 
  

• 4a. Reflects on teaching to identify improvements to enhance future teaching and participates in professional growth opportunities.* 1 2 3
• 4b. Maintains accurate records concerning the instructional program, individual students, and mandated requirements.* 1 2 3 4
• 4c. Fosters effective home-school relationships through the sharing of student and program information.* 1 2 3 4
• 4d. Contributes to the school and district through professional collaboration, participation in school activities, and demonstration of the Franciscan value of service.* 1 2 3 4
• 4e. Shows professionalism through positive peer relationships, mature decision-making, and professional advocacy.* 1 2 3
• Comments on Domain 4:

• ________________________________________________________________________________________

• Additional Comments:
• Leave this field blank

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