TIME LOG - CSN Field Observations

CSN Student: Bettina Ryan

CSN Instructor: Dr. Dale B. Warby

CCSD School Assigned: Ober Elementary School

CCSD Cooperating Teacher: Ms. Jacob

CCSD GradelDepartment: Primary Autism

CCSD School Principal: Melissa Baker

CCSD School Phone & Fax: (702) 799-6077 (702) »>

Record accurate data for all school visitations in the table below

TOTAL HOURS:

10 I
Cooperating Teacher Signature: __ ~--I"~""",,_____________'- __ ~- _--D-a-te-: ==:~-+/1-L-f-)2_'2 ____

CSN Field Observation Packet © CSN Education Department 2017 Page 10

FIELD OBSERVATION STUDENT EVALUATION - completed by Cooperating CCSD teacher

Please complete the following evaluation using the Performance Indicator Scores below (with the student) once
the total observation hours are met. Your constructive comments are extremely valuable to the student. This page
should be returned to the student along with their Time Log. If you prefer to fax or mail the completed documents,
you may do so by sending it to the CSN Professor's attention via Fax: (702) 651-4908 or through regular US mail
to:

CSN North Las Vegas Campus - Education Dept.

3200 E. Cheyenne Ave.
Las Vegas, NV 89030-4228
SORT CODE CYS-222

Enter the appropriate "Performance Indicator Score" in the spaces below

(4)=exemplary (3)=consistent level (2)=not consistent (1 )=Iacking

4 Professional appearance, adherence to CCSD dress code

Reliability, punctuality

4 Communicates effectively with teachers and staff

Demonstrates manners, graciousness

4
4
4 Reflects upon observations using critical thinking

T Demonstrates enthusiasm and curiosity toward the profession

q Models respectful behavior with students

~ Uses appropriate language

_E_ Exhibits pre-service educator success indicators

Cooperating Teacher's Signature: _________~I-.~~I--_________________________________ Date ';! 1J

12'2.

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