Appendix F

STUDENT TEACHER EVALUATION CHECKLIST/COMMENT FORM

Student Teacher Jordan Cullison Semester _Fall 2020__(Final)_____

Cooperating Teacher__Mrs. Debra Seymore______ School __Commonwealth Charter Academy

Components of Professional Practice

Domain 1: Planning and Preparation * Rating Scale

Component 1a: Demonstrates Knowledge of Content and Pedagogy 3 2 1 0

Component 1b: Demonstrates Knowledge of Students 3 2 1 0
Component 1c: Selects Instructional Goals 3 2 1 0
Component 1d: Demonstrates Knowledge of Resources 3 2 1 0
Component 1e: Designs Coherent Instruction 3 2 1 0
Component 1f: Assess Student Learning 3 2 1 0

Domain 2: The Classroom Environment

Component 2a: Creates an Environment of Respect and Rapport 3 2 1 0

Component 2b: Establishes a Culture for Learning 3 2 1 0
Component 2c: Manages Classroom Procedures 3 2 1 0
Component 2d: Manages Student Behavior 3 2 1 0
Component 2e: Organizes Physical Space 3 2 1 0

Domain 3: Instruction

Component 3a: Communicates Clearly and Accurately 3 2 1 0

Component 3b: Uses Questioning and Discussion Techniques 3 2 1 0
Component 3c: Engages Student in Learning 3 2 1 0
Component 3d: Provides Feedback to Students 3 2 1 0
Component 3e: Demonstrates Flexibility and Responsiveness 3 2 1 0

Domain 4: Professional Responsibilities

Component 4a: Reflects on Teaching 3 2 1 0

Component 4b: Maintains Accurate Records 3 2 1 0
Component 4c: Communicates with Families 3 2 1 0
Component 4d: Contributes to the School and District 3 2 1 0
Component 4e: Grows and Develops Professionally 3 2 1 0
Component 4f: Shows Professionalism 3 2 1 0

_2- Proficient____ *Rating Scale: 3-Distinguished, 2-Proficient, 1-Needs Imp., 0-Failing

Recommended Grade
_Debra Seymore_____________________ ___________________________________ ___________________
Evaluator’s Name (please print) Student Teacher’s Signature Date

__3rd grade teacher__________________ ______ __________ __11/17/2020_______

Evaluator’s Title Evaluator’s Signature Date