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 CSN Student: »> lv\W-- ll>I fWe\\
CSN Instructo:r »> \JW J. GI\ d·1no
CCSD School Assigned: >» "Tol1 , re.-N E-
CCSD Cooperating Teacher: >» \--'\ ' WeOl-rnerS
CCSD Grade/Department: >» L\1.D g 00,€.;
CCSD School Principa:l >» 10 DCX-vi Y""

CCSD School Phone & Fax: (702) »> '7IJ, ...-( G°.1Lj (702) »> 7'Jrt:'J ,.1 i
Record accurate data for all school visitations in the table below

\·.oomr
\:00r(l

TOTAL HOURS:

Coope,atiagTeache,S;Jaaw," Date
.'

CSN Field Observation Packet © CSN Education Department 2017 Page 9

FIELD OBSERVATION STUDENT EVALUATI • comp e e by Coopera ng eacher

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)=conslstent level (2)=not consistent (1)=Iacklng

$ Professional appearance, adherence to CCSD dress code

_j_ Reliability, punctuality

_!:J_ Communicates effectively with teachers and staff

_!J_ Demonstrates manners, graciousness

_!j_ Reflects upon observations using critical thinking

_1_ Demonstrates enthusiasm and curiosity toward the profession

f !j_ Models respectful behavior with students

Uses app,oprlaffi laagoage

Exhibits pre-service educator success indicators

Coopera'"g TeacheCs Slgoat, ce DaffiJ{}-:)-;)-

CSN Field Observation Packet © CSN Education Department 2017 Page 10