Post-Formal Observation Reflection Form—Teacher and Evaluator

Teacher (print) Building & Evaluator (print):

Date of Post-Conference: Date/Time of Observation:

Grade Level/Curriculum Area Observed:

1. Reflect upon the engagement of your students during the lesson. What adjustments did you make
to increase and/or maintain the engagement of all students?

2. How do you know whether the students learned what you intended?

If the students didn’t learn what you intended, what are your next steps?

3. Which goals or instructional plans, if any, did you alter as you taught the lesson? If so, why?

4. Reflect upon or provide 3 examples of student work (high achieving, average achieving and low
achieving) related to this lesson. These should reflect the full range of student ability in your class
and include feedback to students.

5. What will you do differently or the same the next time you teach this lesson?

6. Evaluator reflection, including but not limited to feedback requested in Pre formal observation
conference.

*Teacher Signature and Date: Evaluator Signature and Date:

Name (print): Stephanie Carnes Date: 5/6/19 Name (print): David Ruehs Date: 5/6/19
Signature: Stephanie Carnes (Digital Signature) Signature: David Ruehs (Digital Signature)
*The teacher’s signature notes that the teacher acknowledges review of this formal post-observation form with the
evaluator but does not necessarily indicate agreement with the observation results (#6). If received, the teacher may
respond within ten (10) school days after receiving a copy of this form. Copies shall go to the evaluator and evaluatee.