Prospective CAP Instructor
Observation Form
All documentation is due in the CAP Office by the last Friday in May.
*Be sure to sign in at the high school office before proceeding to the classroom.
Teacher Name _______________________________ Course Title ______________________________
High School ____________________________________________ Date of Visit ______/______/______
Liaison Name ____________________________________ Date Report Submitted _____/_____/______
*If convenient, you may use a personal vehicle and be reimbursed for mileage if odometer readings are entered,
below. To arrange use of a departmental vehicle, please contact the CAP Office at 812/228-5022.
Mileage at Departure _______________________ Departure Location (USI or Home) _______________
Mileage at Return __________________________ Return Location (USI or Home) _________________
I recommend that the above instructor be invited to attend a College Achievement Program
(CAP) professional development workshop and upon attendance and approval of the course
syllabus, content, assessment and delivery, be approved to offer a concurrent enrollment course
via the College Achievement Program (CAP).
I do not recommend the above instructor for participation in the College Achievement
Program (CAP) due to the following reasons:
I would consider re-evaluating the above instructor for participation in CAP if the following steps
were taken (i.e. successful completion of 6 hours of graduate credit in the subject or participation
in a departmental professional development event):
Faculty Liaison Signature_____________________________________ Date ______________________
(if submitting digitally, include digital signature, CAP staff can create if needed )
Observations/Comments
Payments for observation visits are made upon submission of the report and
supporting paperwork. Be certain all visits are conducted and all documentation
submitted to the CAP office no later than the last Friday in May, so that payments
can be made from the current operating budget (no later than June 30).
For CAP Office Use Only
Report received and reviewed by CAP staff.
Liaison stipend processed.
Revised
6/20/11 jdd
Initials
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Initials
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