Single Subject 155A Mid-Term Evaluation Form
Please complete this evaluation form for each candidate you are mentoring.
Date: _____________________
Candidate’s First Name: _____________________
University Coach: _____________________
Grade/Content Area: _____________________
School Site: _____________________
Candidate’s Last Name: _____________________
Mentor Teacher: _____________________
Mentor Teacher’s Email: _____________________
Planning:
| Criterion | Performance Rating | Does Not Meet Expectations 1 | Meets Expectations 2 | Meets Expectations at a High Level 3 | Exceeds Expectations 4 | Score |
|---|---|---|---|---|---|---|
| Subject specific pedagogy TPE 3.1, 3.3, 3.5 | Lesson plans include content and related activities or strategies inconsistent with current subject-specific pedagogy and standards, with limited support for acquisition or use of academic language. | Lesson plans’ content and related activities or strategies that: (a) are consistent with current subject-specific pedagogy and standards and (b) support the acquisition or use of academic language. | Lesson plans include content and related activities or strategies that: (a) are consistent with current subject-specific pedagogy and standards and (b) provide multiple opportunities for students to acquire and use academic language. | Lesson plans include content and related activities or strategies adapted for specific needs of students that: (a) are consistent with current subject-specific pedagogy and standards, (b) provide multiple opportunities for students to acquire and use academic language, and (c) include clear evidence of a plan to monitor students’ access to content. | [FORM FIELD] Planning Pedagogy: Score: 0 | |
| Applying Knowledge of Students TPE 3.2, 4.1, 4.2 | Information about Students, gathered by the candidate, provides little or no useful information for planning. Candidate plans activities or strategies that demonstrate little or no understanding of the connection between knowledge of students and promoting access to content. | Information about students, gathered by the candidate, provides useful information for planning. Based on a general knowledge of students at this grade level, candidate plans appropriate activities or strategies to promote access to content. | Information about students, gathered by the candidate, provides useful information for planning. Based on knowledge of students in this class, candidate plans appropriate activities or strategies that include accommodations or modifications to promote access to the content. | Candidate gathers relevant and detailed information on students to be used for planning. Based on knowledge of individuals or groups of students in the class, candidate plans appropriate activities or strategies that include accommodations or modifications to promote access to the content specifically referencing these students. | [FORM FIELD] Applying Knowledge: Score: 0 | |
| Student Engagement TPE 1.1, 1.3, 1.5, 4.7 | Candidate plans few or inappropriate methods for student engagement. | Candidate’s plans for engaging students are appropriate to the grade level (e.g., real-life contexts, connections to students’ experiences or interests, opportunities for critical or creative thinking, varied communication on strategies). | Candidate’s plans for engaging students include varied methods appropriate to students in this class (e.g., real-life contexts, connections to students’ experiences or interests, opportunities for critical or creative thinking, varied communication strategies). | Candidate’s plans for engaging students include varied methods specifically connected to the backgrounds and needs of individuals or groups of students in the class (e.g., real-life contexts, connections to students’ experiences or interests, opportunities for critical or creative thinking, varied communication strategies). | [FORM FIELD] Student Engagement: Score: 0 |
Implementation:
| Criterion | Performance Rating | Does Not Meet Expectations 1 | Meets Expectations 2 | Meets Expectations at a High Level 3 | Exceeds Expectations 4 | Score |
|---|---|---|---|---|---|---|
| Subject specific pedagogy TPE 3.1, 3.3, 3.5 | Candidate implements instruction inconsistent with subject-specific pedagogy or not in alignment with the identified academic content standard(s). Instruction fails to or inadequately supports students’ acquisition of academic language. | Candidate effectively implements instruction consistent with subject-specific pedagogy to teach the identified academic content standard(s). Instruction supports the acquisition or use of academic language appropriate for students at this grade level. | Candidate effectively implements and monitors instruction consistent with subject-specific pedagogy to teach the identified academic content standard(s). Incorporates effective instructional strategies and materials to support the acquisition and use of academic language for students in this class. | Candidate effectively implements and monitors instruction consistent with subject-specific pedagogy that clearly matches the level and content of the identified academic content standard(s). Demonstrates effective integration of instructional strategies and materials to support the acquisition and use of academic language for specific needs of individuals or groups of students in this class. | [FORM FIELD] Subject Specific: Score: 0 | |
| Applying Knowledge of Students TPE 1.1, 3.2 | Candidate demonstrates little or no awareness of the learning needs, backgrounds, and interests of students at this grade level. | Candidate uses their knowledge of the learning needs, backgrounds or interests of students at this grade level to keep them on task. | Candidate uses their knowledge of the learning needs, backgrounds or interests of the students in this class to increase access to the content. | Candidate adjusts instruction in response to the specific learning needs, backgrounds, interests, and experiences of individuals or groups of students in the class to increase access to the content. | [FORM FIELD] Applying Knowledge 2: Score: 0 | |
| Student Engagement TPE 1.3, 1.5, 1.8, 2.2, 2.6 | Candidate uses inadequate techniques to promote and monitor participation by students in the learning activities. Candidate inadequately expresses or reinforces expectations for behavior. The candidate models few or no positive interactions. | Candidate uses primarily management techniques to promote and monitor participation by students in the learning activities. Candidate expresses and reinforces expectations for social or academic behavior. Candidate models generally positive interactions. | Candidate uses both management and instructional techniques (e.g., questioning, real life contexts, opportunities for critical or creative thinking) to promote and monitor active participation by students in the learning activities. Candidate expresses and reinforces expectations for social and academic behavior. Candidate models interactions that create a positive learning environment of respect for diversity and multiple perspectives. | Candidate is able to use primarily instructional techniques (e.g., questioning, real life contexts, opportunities for critical or creative thinking) to ensure and monitor active and equitable participation by students in the learning activities. Candidate expresses and reinforces expectations for social and academic behavior. Both the candidate and the students consistently model interactions that create a positive learning environment of mutual respect for diversity and multiple perspectives. | [FORM FIELD] Student Engagement 2: Score: 0 |
Professional Competencies (to be completed by/as per input from Mentor Teacher):
Yes No
Takes initiative.
Handles information about children, peers, families, colleagues, and supervisors
ethically.
Accepts constructive criticism and suggestions.
Is punctual (arrives on time, submits assignments in a timely manner, etc.)
Respects the attitudes and opinions of others.
Has attended a professional conference, in-service training, or school site/district
meeting.
Rubric Score:
Rubric Mean:
University Coach Comments (Candidate’s strengths, areas for growth, other comments):
[FORM FIELD] Rubric Score: 0
[FORM FIELD] Rubric Mean: 0
Mentor Teacher Comments (candidate’s strengths, areas for growth, other comments):
Optional Second Mentor’s Comments (candidate’s strengths, areas for growth, other
comments):
Teacher Candidate Comments:
University Coach’s Signature:
Teacher Candidate’s Signature:
Mentor Teacher’s Signature:
Second Mentor’s Signature (optional):
University Coach’s Recommendation: Yes, I recommend the Candidate to continue in
the program.
No, I do not recommend the Candidate to continue in the program (please submit a
Statement of Concern form).
This PDF is provided as a print-only reference document and may not be fully accessible to users of assistive technology. For more information, please visit Title II Rule on Digital Accessibility page.