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. Please complete the entire top portion in addition to

completing all the remaining information. If you print this form to submit as a handwritten document, please highlight your assessment for each
criterion and enter comments in the space indicated (please use the bac of the form if more space is necessary!. If you wish to complete this
form electronically, please email your re"uest to #a$ern %ecrest (lsecrest&mvnu.edu! in the 'ducation (epartment at )ount $ernon *a+arene
,niversity and she will send you an electronic copy. -hen completing an electronic form, please use the drop down bo. to assess each
criterion, enter comments, and then print a copy to tae to the final evaluation with the candidate and the university supervisor.
P#/**I*0: ,sing 1nowledge of %tudents, Content, 2 /ssessment Teacher Comments
,nacceptable /cceptable Competent '.emplary
3
-rites clear,
appropriate,
ob4ectives
Objectives do not have
measureable
outcomes and are not
aligned with standard,
or are not appropriate
Objectives are
appropriate, loosely
aligned with
measureable
outcomes and
standards
Objectives are clear
with measureable
outcomes, aligned with
standards
Non Applicable Competent
Comments:
5
Identifies and
supports
content
specific
academic
language
Language demands
vaguely related to
lesson
Candidate identifies
content specific
academic language
and provides limited
support for student
practice, development,
and demonstration of
abilities
Candidate justifies
content specific
academic language
and provides
opportunities for
student practice,
development,
demonstration of their
abilities
Non Applicable Competent
Comments:
6 Non Applicable Acceptable
Candidate *ame: )egan 7olmberg
*ame of Person
Completing
/ssessment: )egan 7olmberg
(ate: 3589836
0rade #evel:
:t
h
C/*(I(/T' P;O<I#'
'C'8)C'6=:3 (evelopmental
#iteracy #ab
>ecoming
familiar with
all students?
bacground
nowledge,
language,
culture, and
e.periences
Lacks familiarity with
all students
background knowledge
and e!periences and
does not know how to
obtain that information"
#amiliar with
background knowledge
and e!periences of
some students and
familiar with ways to
obtain that information
primarily through
strategies such as
discussion,
conferencing, and
observations
#amiliar with
background
knowledge,
e!periences, learning
styles, interests, and
culture of most
students and familiar
with ways to obtain
that information
primarily through
strategies such as
discussion,
conferencing, and
observations"
Comments: $t is hard to get to know students on
a more personal level in the short amount of
time that we are actually in the classroom, but $
really enjoyed getting to know the students"
%his is something that in the future $ would like
to work on more"
:
Creating or
selecting
appropriate
teaching
methods,
activities, and
materials
Chooses methods,
materials, and
activities that are
unrelated to the
goals&objectives of the
lessons or that are not
appropriate to the
students"
'sually chooses
methods, materials,
and activities that are
aligned with the lesson
goals&objective and are
appropriate to students
in general"
(elects instructional
formats appropriate to
goals&objectives being
taught) selects variety
of instructional
resources and
materials) designs
activities that foster
student involvement
with the lessons"
Non Applicable Competent
Comments: $ try to incorporate a variety of
learning strategies for all the different types of
learners present in the classroom" (tudents
gave me positive feedback on my lessons that $
taught, which gave me the confidence that $ am
teaching appropriate methods for learning"
@
Creating or
selecting
appropriate
evaluation
strategies
*oes not
systematically evaluate
student learning)
evaluations are
inappropriate to the
goals&objectives of
lessons or to the
students"
+valuates student
learning in ways that
are aligned with the
goals&objectives of the
lessons and that are
appropriate to the
students in general"
(ystematically
evaluates students
learning in ways that
are aligned with lesson
goals&objectives and
appropriate to all
students"
Non Applicable Acceptable
Comments:
A
Opportunities
for learner
selfB
assessment
#eedback provided
focuses on errors
Learners provided
feedback related to
student competencies
and needed
improvement
,rovides opportunities
to involve learners in
self-assessment
through clear feedback
Non Applicable Acceptable
Comments:
C Non-Applicable Competent
1nowledge of
student
learning and
development
,lanning does not
reflect an
understanding of
students cognitive,
social&emotional
development, and
physical development
,lanning reflects
learning activities
based on students
cognitive,
social&emotional
development, and
physical development
,lanning reflects
learning activities
based on students
cognitive,
social&emotional
development, and
physical development)
specifically addresses
different needs
Comments: $ keep in mind that middle
childhood students are beginning to develop
reapidly" *uring this time of great change, their
peers are very important to them" $ keep all this
in mind when designing lessons, and do my
best to reach students of all levels by letting
them do group work when appropriate"
D
(emonstratin
g nowledge
of content
and
instructional
strategies
.akes content errors)
does not correct
content errors students
make"
*isplays minimal
content knowledge and
corrects some errors
students make"
*isplays solid content
knowledge and
corrects errors
students make) uses
specific language of
discipline when
teaching lessons and
utili/es appropriate
instructional strategies"
Non-Applicable Competent
Comments:
9
Connects
content to
e.periences
and interests
Little or no evidence
provided linking
childrens prior learning
or interests
,lans reflect attempt to
link prior learning and
new content
,lanning reflects
students are engaged
in content with
intentional links made
between prior learning,
new content, student
interests through
discussions and
literature"
Non-Applicable Acceptable
Comments: $t is so important to build on prior
background knowledge" %hese connections are
what create learning" $ did my very best to
make these connections and associations as $
taught"
I*%T;,CTIO*: (elivering 'ffective Instruction
Teacher Comments
,nacceptable /cceptable Competent '.emplary
3
/rticulating
clear and
appropriate
learning
goals,
ob4ectives,
and8or
standards
*oes not articulate
clear learning
goals&objectives&
standards or chooses
goals&objectives&
standards that are
inappropriate"
'sually articulates
clear learning
goals&objectives&
standards that are
appropriate"
Lesson plans clearly
distinguish goals from
activities and support
choice of
goals&objectives by
noting standards when
appropriate"
Non Applicable

Acceptable
Comments:
5 Non Applicable Competent
)aing
learning
connections
No evidence of
understanding that
content of one lesson
relates to content of
previous or future
lessons or inaccurate
understanding of how
lessons relate"
Lesson plans reflect
minimum
understanding of
connection between
content in previous
lessons and current
lessons"
Lesson plans reflect
understanding of
connection between
content in previous,
current, and future
lessons) candidate
plans strategies that
help students make
connections, and
refers to scope and
se0uence of
district&state standards"
Comments: $ referenced past teaching as $
taught, and let students know how the
information they were learning would be used in
the future"
6
(emonstratin
g appropriate
communicati
on sills
(poken or written
communication
contains grammar and
synta! errors)
vocabulary is
inappropriate for
students ages or
backgrounds)
0uestions are of poor
0uality"
(poken and written
language is usually
clear and correct and
vocabulary is
appropriate to
students ages or
backgrounds)
0uestions are
effectively asked"
(poken and written
language is
consistently correct
and e!pressive, with
well-chosen
vocabulary that
enriches the lessons)
utili/es effective
0uestioning strategies
including distribution of
0uestions to all
students, wait time,
and prompting for
answers"
Non Applicable Acceptable
Comments:
:
/ctively
engages
students in
lessons
*iscourages students
from thinking
independently,
creatively, or critically"
+nables students to
move beyond the facts
and e!tend their
thinking) asks a
variety of 0uestions at
all levels of 1looms
%a!onomy"
+ncourages students
to think independently,
creatively, or critically)
asks a variety of
0uestions at all levels
and asks students for
opinions or alternative
e!planations"
Non Applicable Competent
Comments: $ used a variety of learning
strategies and activities to keep students
engaged"
@
Practice
provided for
students to
demonstrate
content
understandin
g
Language of content
not encouraged or
practiced"
Opportunities for
practice and feedback
provided"
,rovides students
e!plicit models,
opportunities for
practice, and feedback"
Language of content
encouraged"
Non Applicable Acceptable
Comments:
A (ubstantial amounts of
instructional time are
2elevant work or
activities are provided
.eaningful work of
instructional value is
Non-Applicable Competent
,ses
instructional
time
effectively
spent on activities of
little value) pacing of
lessons is
inappropriate to
content or students"
and pacing of the
lessons is appropriate)
non-instructional
procedural matters do
not occupy an
e!cessive amount of
time"
provided throughout all
lessons) pacing is
appropriate) has
established procedures
for transitions, group
work, obtaining help,
beginning and ending
the day, distributing
and collecting
materials, sharpening
pencils, and using the
restroom"
Comments: $ used effective introductions and
conclusions" $ allowed students time to reflect
on each lesson as a way to wrap everything up"
C
Incorporating
technology
into
curriculum
%echnology is seldom
used to support
teaching or student
learning"
Occasionally uses a
variety of technology to
support teaching
and&or student
learning) uses software
to increase
productivity"
Often uses a variety of
technology in lessons
and guides students to
use $nternet and
software to locate
information related to
units of study as
appropriate and
available"
Non-Applicable Acceptable
Comments:
#'/;*I*0 '*$I;O*)'*T: Creating a #earning 'nvironment to Promote /chievement
Teacher Comments
,nacceptable /cceptable Competent '.emplary
3
'stablishes
safe learning
environment
$s negative or unfair in
the treatment of some
students) tolerates
unfair behavior among
students) makes or
accepts comments
about students that are
demeaning and
stereotyping
$s fair in the treatment
of all students) does
not tolerate unfair
behavior among
students or accept
comments that are
demeaning, based on
stereotypes or
otherwise unfair
$s fair in the treatment
of all students) does
not tolerate unfair
behavior among
students or accept
comments that are
demeaning or unfair)
promotes fairness
among students
Non Applicable Competent
Comments:
5
'nvironment
conducive to
learning
*oes not have
materials and
resources prepared,
organi/ed, and&or
accessible prior to
teaching lesson"
'sually has materials
and resources
prepared, somewhat
organi/ed, and
accessible before each
lesson"
Always has materials
and resources
prepared, organi/ed,
and accessible prior to
teaching"
Non Applicable Acceptable
Comments: 3eeping materials organi/ed and
ready was somewhat of a challenge because $
did not have my own space to lay out materials
in the classroom"
6 Non Applicable Acceptable
'stablishing
and
maintaining
consistent
standards of
classroom
behavior
.akes little or no
attempt to respond to
disruptive behavior or
response to disruptive
behavior is
inappropriate"
Aware of the entire
room) communicates
e!pectations, responds
to poor behavior)
demonstrates respect
for all students"
*emonstrates a
proactive approach to
discipline) consistent
with e!pectations and
follows through)
responses to
misbehavior are timely,
appropriate and
effective
Comments: 4hile $ maintain control in the
classroom, $ need to work on controlling the
volume level of students, monitoring what they
are saying so that the class does not lose track
or become off topic"
:
Classroom
procedures
and activity
transitions
are
implemented
effectively
,rovides the students
with no information,
confusing information,
or inaccurate
information about the
learning goals or the
instructional
procedures" .akes
little or no attempt to
determine whether
students are
understanding content)
gives little or no
feedback"
'sually provides
students with clear,
accurate information
about the goals and
instructional
procedures" .onitors
the understanding of
the content throughout
lessons by checking
work, asking
0uestions, attending to
nonverbal cues, etc")
gives feedback to
students as necessary"
Consistently provides
students with clear,
accurate information
about goals and
procedures) gives
clear, concise
directions by stating
them, writing them,
modeling them, and
doing one or two
together) ensures that
most students
understand and can
carry out instructional
procedures" .onitors
the understanding of
the content through a
variety of means and
adjusts instruction if it
isnt working; provides
substantive feedback
on progress in a timely
fashion, promptly
returning daily work
and assessments"
Non-Applicable Acceptable
Comments:
@
Creates
appropriate
group
learning
situations
Learning situations are
not aligned with
instructional goals,
available resources,
and&or learner
characteristics"
Learning situations
created are loosely
aligned with
instructional goals,
available resources,
and&or learner
characteristics"
Learning situations
created are aligned
with instructional goals,
available resources,
learner characteristics,
and are conducive for
most learners"
(tudents work well
independently,
collaboratively, or as a
whole class"
Non-Applicable Competent
Comments: $ had students work individually, in
small groups, and as a whole class" 5roup
learning can be effective when used
appropriately"
A
'stablishing
and
maintaining
rapport with
students
*oes not attempt to
establish rapport with
students or the
attempts are
inappropriate) does not
relate positively to
students as people"
+stablishes a basic
level of rapport with
students) shows
concern and interest)
makes eye contact,
smiles, and takes time
to listen"
+stablishes good
rapport with students)
shows concern and
interest) demonstrates
enthusiasm,
confidence, warmth,
sincerity, and humor)
relates positively) takes
time to listen and
shows an
understanding of
students lives outside
of school"
Non-Applicable Competent
Comments: %he students at this particualr field
placement were very warm, and $ felt that they
really enjoyed my company" $ worked to
develop positive rapport with each of my
students"
P;O<'%%IO*/#I%): Collaboration, Communication, Professional ;esponsibility, 2 0rowth
Teacher Comments
,nacceptable /cceptable Competent '.emplary
3
(emonstratin
g e.emplary
attendance
and
punctuality
Arrives to school late
or leaves early) is not
punctual for
assignments) many
absences"
Arrives and leaves
school on time) is
punctual for most
assignments) has very
few absences"
Arrives and leaves on
time) is punctual for all
assignments) few
absences) attends out-
of-class events"
Non Applicable Competent
Comments: $ tried to let my C% know if $ would
be coming in at alternate hours , and $ did my
best to always be punctual"
5
%howing
evidence of
physical and
emotional
wellBbeing
#re0uently sick, tired,
or unable to maintain
physical or emotional
health to teach)
presents an
unprofessional or
inappropriate
appearance"
6ealthy, physically and
emotionally) is ready to
teach most days)
presents a professional
and appropriate
appearance"
6ealthy and
consistently ready to
teach) presents a
professional and
appropriate
appearance) displays a
positive attitude"
Non Applicable Competent
Comments:
6
Collaborates
and
communicate
s with
appropriate
professionals
*oes not effectively
collaborate with
colleagues, specialists,
parents&guardians,
and&or others in the
school, district, or
university"
5enerally collaborates
with colleagues,
specialists,
parents&guardians,
and&or others in the
school, district, or
university"
Collaborates effectively
with colleagues,
specialists,
parents&guardians, and
others) seeks help
from other
professionals on
matters related to
teaching"
Non Applicable Competent
Comments:
:
%ees
opportunities
to impact
teaching
"uality and
student
achievement
.akes little or no
attempt to find ways to
help students who fail
to meet the learning
goals"
Attempts to find ways
to help students who
fail to meet learning
goals"
Consistently suggests
ways to address
specific learning needs
of students"
Non Applicable Acceptable
Comments:
Teacher Comments
,nacceptable /cceptable Competent '.emplary
E:a.3:
Candidate
displays
nowledge of
culturally
responsive
academic
language and
can apply it in
their practice.
'.ample:
%'%,
/chievement
0ap,
'thnicity,
;ace, color
blind, deficit,
meritocracy,
poverty,
e"uity etc.
Candidate either does
not have knowledge of
or is only at an
awareness level
regarding culturally
responsive academic
language" %here is no
evidence of changed
behavior by the
candidate in their
practice"
Candidate uses
person-first language
and has an accurate
self-assessment
regarding their
e!periences and
beliefs in regards to
culture and diversity
academic language,
however there may not
be a consistent
connection to practice"
Candidate fully
understands culturally
responsive academic
language and uses the
terms accurately and
consistently in their
practice"
Non Applicable

Acceptable
Comments:
E:a.::
Candidate
ac"uires and
integrates
nowledge of
students with
cultural and
diverse
e.periences.
'.ample:
(emonstrates
importance
and use of
the physical,
cognitive,
emotional,
social and
cultural
characteristic
s of students?
in planning
and a desire
to inform
candidate?s
practice
Candidate either does
not have knowledge of
or is only at an
awareness level of
student7s culture and
diverse e!periences
and learning needs"
Candidate is sensitive
to student7s culture and
diverse e!periences
and learning needs,
however there may not
be a consistent
connection to
Candidate fully
understands student7s
culture and diverse
e!periences and
learning needs, uses
the information
consistently in practice,
and seeks
opportunities to foster
a culturally responsive
climate between
students, school, and
the community"
Non Applicable Acceptable
Comments: $ need to continue developing my
knowledge of potential cultural differences $ will
e!perience in the classroom, so that $ can best
reach each student"
:a.@:
Candidate
nows and
can integrate
best practice
models for
Candidate either does
not have knowledge of
or is only at an
awareness level of
best practice models
for students with
Candidate has an
accurate self-
assessment regarding
their e!periences and
beliefs in regards to
best practice models of
Candidate fully
understands best
practice models, is
consistently using
e!tensive and varied
strategies for students
Non Applicable Acceptable
Comments:
students with
e.ceptionaliti
es in their
practice.
'.ample:
,ses, in
conte.t and
construct,
evidenced
based
strategies,
accommodati
ons,
adaptations
and
modifications
specific to
students?
learning need
e!ceptionalities in their
practice"
differentiation for
students with
e!ceptionalities,
however there may not
be a consistent
connection to practice"
with e!ceptionalities,
and takes action to
review evidence-based
current and developing
trends to apply in their
practice"
Comments:
:a.A:
Candidate
nows and
can integrate
best practice
models for
'nglish
#anguage
#earners in
their practice.
'.ample:
(emonstrates
nowledge of
the
characteristic
s associated
with '##?s
and the
specific
instructional
choices to
ma.imi+e the
optimal
learning
outcome for
'##?s
Candidate either does
not have knowledge of
or is only at an
awareness level of
best practice models
for +nglish Language
Learners in their
practice"
Candidate has an
accurate self-
assessment regarding
their e!periences and
beliefs in regards to
best practice models of
differentiation for
+nglish Language
Learners, however
there may not be a
consistent connection
to practice"
Candidate fully
understands best
practice models, is
consistently using
e!tensive and varied
strategies for +nglish
Language Learners,
and takes action to
review evidence-based
current and developing
trends to apply in their
practice"
Non Applicable Acceptable
Comments:
E:a.C:
Candidate
demonstrates
a positive
disposition
toward
culture and
diversity
'.ample:
(emonstrates
characteristic
s of e"uity,
4ustice and
understandin
g of others to
change own
behavior and
to influence
others
towards
cultural
responsivene
ss in lifestyle
in classroom
and in
community
Candidate complies
with legal re0uirements
and&or is only aware of
differences yet does
not have the
knowledge to
understand why they
would want to change
their behavior"
Candidate is aware of
culture and diversity
issues and is willing to
meet the needs of
others" %his causes
minor changes in
behavior, yet does not
fully impact beliefs,
e!pectations, and
assumptions"
Candidate consistently
applies knowledge and
skills regarding beliefs
of self and others to
significantly change
day-to-day behavior
within the conte!t of
culture and diversity"
Non-Applicable Competent
Comments: $ did my best to be aware of
students beliefs so that $ could understand their
perspectives" %his allows you to connect with
students on a deeper level"
/rtifact ;eflection %coring
Category ,nacceptable /cceptable Competent '.emplary Competent
Artifact
2eflection:
Artifact fails to include
supporting description
Artifact description
consists of date
created,
identification of
course, and how
artifact relates to
candidates
Artifact description
includes date
created, conte!t
surrounding its
creation, reflections
concerning artifact
strengths and
Artifact description
includes date
created) and
integrated,
thoughtful reflections
concerning conte!t,
artifact and
Comments:
competence weaknesses 8role9,
and how it
demonstrates
competence in
associated
outcome&standard
candidate strengths
and weaknesses
8role9, and
associated
outcome&standard