Single Subject 155B 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: _____________________
Criterion Performance Rating
Maintaining Effective Environments – TPEs 2.1, 2.3, 2.6
Does Not Meet Expectations 1
Expectations for, and responses to, behavior are limited to inappropriate for maintaining
control of the class. Routines are unclear or ineffective.
Meets Expectations 2
Expectations for, and responses to, behavior are designed to maintain control of
the class. Routines focus primarily on management.
Meets Expectations at a High Level 3
Expectations for, and responses to, behavior are designed to maintain control of
the class and promote positive, fair and respectful treatment of students. Routines
are designed to facilitate learning, not just management.
Exceeds Expectations 4
Expectations for, and responses to, behavior are designed to promote individual
responsibility, multiple perspectives, and an inclusive environment for all students.
Routines are designed to facilitate independent learning and regular student-to-student
interactions.
Score
[FORM FIELD] MaintainingScore: 0
Monitoring Student Learning and Making Adjustments During Lessons – TPEs 1.8, 3.2
Does Not Meet Expectations 1
No or limited monitoring of students and adjustment to the lesson. Focus is on external
factors (e.g., time, schedule) rather than student behavior or learning.
Meets Expectations 2
Monitoring of students and adjustment to the lesson are focused primarily on behavior
or lesson structure rather than student learning.
Meets Expectations at a High Level 3
Monitoring of students and adjustment to the lesson are focused on student learning
and engagement.
Exceeds Expectations 4
Monitoring of students and adjustment to the lesson are focused on providing access
to the content for specific students and encouraging active engagement by all students.
Score
[FORM FIELD] Monitoring Score: 0
Subject-Specific Pedagogy – TPEs 1.3, 1.5, 3.1, 3.3, 4.4, 4.7
Does Not Meet Expectations 1
Lesson objectives and instruction are not clearly related to content or literacy
standards. Instruction is: (a) ineffective or inconsistent with current subject-specific
pedagogy, (b) includes a limited variety in instructional and engagement strategies.
Meets Expectations 2
Lesson objectives and instruction primarily address either content or literacy standards,
focusing primarily on lower levels of learning. Instruction is: (a) consistent with
current subject-specific pedagogy, (b) includes a variety of instructional and engagement
strategies.
Meets Expectations at a High Level 3
Lesson objectives and instruction clearly address both content and literacy standards,
including a focus on higher level learning. Instruction is: (a) consistent with current
subject-specific pedagogy, (b) includes a variety of instructional and engagement
strategies, (c) provides opportunities for critical and creative thinking.
Exceeds Expectations 4
Lesson Objectives and instruction seamlessly integrate content and literacy standards,
focusing on higher level learning and real world connections. Instruction is: (a)
consistent with current subject specific pedagogy, (b) includes a variety of instructional
and engagement strategies, (c) provides opportunities for critical and creative thinking,
(d) utilizes a range of communication or activity modes.
Score
[FORM FIELD] Subject Pedagogy Score: 0
Addressing Needs of All Students – TPEs 1.6, 4.1, 5.8
Does Not Meet Expectations 1
Instructional approaches are limited or inappropriate for at least two of the following
groups: (a) different levels of English proficiency, (b) students with identified
special needs, (c) students with different instructional needs.
Meets Expectations 2
Instructional approaches are generally appropriate for at least two of the following
groups: (a) different levels of English proficiency, (b) students with identified
special needs, (c) students with different instructional needs.
Meets Expectations at a High Level 3
Instructional approaches are specifically aligned with the needs of at least two
of the following groups: (a) different levels of English proficiency, (b) students
with identified special needs, (c) students with different instructional needs.
Exceeds Expectations 4
Instructional approaches are specifically aligned with the needs of all the following
groups: (a) different levels of English proficiency, (b) students with identified
special needs, (c) students with different instructional needs.
Score
[FORM FIELD] Addressing Needs Score: 0
Assessment – TPEs 4.3, 5.2
Does Not Meet Expectations 1
Assessments: (a) lack congruence with learning outcomes and level of learning (e.g.,
DOK level), (b) include little or no attention to the assessment of content knowledge
or literacy skills, (c) reflect a “one size fits all” method of assessment.
Meets Expectations 2
Assessments: (a) are congruent with learning objectives in either content or level
of learning (e.g., DOK level), (b) primarily assess either content knowledge or literacy
skills, (c) reflect some variety of methods for students to demonstrate learning,
(d) primarily assess lower level learning.
Meets Expectations at a High Level 3
Assessments: (a) are congruent with learning objectives in content and level of
learning (e.g., DOK level), (b) include assessment of both content knowledge and literacy
skills, (c) reflect a variety of methods for students to demonstrate learning, (d)
include assessment of higher level thinking (e.g., complex task).
Exceeds Expectations 4
Assessments: (a) are clearly congruent with the learning outcomes in both content
and level of learning (e.g., DOK level), (b) include specific attention to the assessment
of integrated content knowledge and literacy skills, (c) reflect a variety of methods
for students to demonstrate learning, (d) include those requiring an integration of
knowledge, skills, and reasoning, (e) include student choice or ways to demonstrate
learning.
Score
[FORM FIELD] Assessment Score: 0
Rubric Score
Rubric Score:
Rubric Mean:
Professional Competencies
Yes No
Takes initiative.
Handles information about children, peers, families, colleagues, and supervisors
ethically.
Accepts criticism and suggestions from the Master Teacher and/or University Supervisor.
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, or meeting.
University Coach Comments (Candidate’s strengths, areas for growth, other comments):
[FORM FIELD] Rubric Score: 0
[FORM FIELD] RubricMean: 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 Verification and Recommendation
Enter date University Coach verified the Time Log:
University Coach’s Recommendation: Yes, I recommend the Candidate to continue in
the program.
No, I do not recommend the Candidate to complete the program (please submit a Statement
of Concern form).
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