FORM
7: SOWIC Psychologist Appraisal System
Year 1, Segments 3 & 4 Formative Feedback
Psychologist: Click here to enter text.
School: Click here to enter text.
Grade Level(s): Click here to enter text.
Subject(s): Click here to enter text.
Observer: Click here to enter text.
Date: Click here to enter text.
Conversation Components
Domain 1
Domain 4
Planning and Preparation
Professional
Responsibilities
1a: Demonstrating knowledge
and skill in using
psychological instruments
to evaluate students
1b: Demonstrating knowledge of
child and adolescent
physical, social and
cognitive development.
1c: Establishing goals for
remediation
strategy/intervention
services appropriate to the
setting and the students
served.
1e: Planning remediation
strategy/intervention
services, integrated with the
regular school program, to
meet the needs of individual
students
4b: Communicating with Problem
Solving and IEP teams so
they understand the
psychological findings
4d: Participating in a
Professional Learning
Community – emphasis on
the positive and supportive
interactions while
demonstrating leadership.
Observable Components
Domain 2
Domain 3
Classroom Environment
Instruction
2a: Establishing rapport with
students, using
interpersonal skills, such as
empathy to establish trust
and reduce anxiety
2c: Establishes and Maintains
Clear Procedures for
Problem Solving Referrals,
Meetings, and
Consultations. Practice
includes ability to prioritize,
meet deadlines and
complete documentation.
2d: Establishing standards of
conduct for all Interactions
with Students
2e: Organizing physical space
for testing of students and
storage of materials in each
building across the district.
3a: Responding Appropriately
and Readily to Referrals,
Consults with Teachers and
Administrators, and
Accurately Evaluating
Students’ Needs.
3c: Facilitating students’
determination of eligibility for
special education and
subsequent development of
the Individual Education Plan
(I.E.P.)
Conversation should focus on celebrations and areas needing further concentration.
Domain 1 (Planning and Preparation) Feedback
Click here to enter text.
2a. Establishing rapport with students, using interpersonal skills, such as empathy to establish trust and reduce anxiety
Click here to enter text.
2c. Establishes and Maintains Clear Procedures for Problem Solving Referrals, Meetings, and Consultations. Practice includes ability to prioritize, meet
deadlines and complete documentation.
Click here to enter text.
2d. Establishing standards of conduct for all Interactions with Students
Click here to enter text.
2e. Organizing physical space for testing of students and storage of materials in each building across the district
Click here to enter text.
3a. Responding Appropriately and Readily to Referrals, Consults with Teachers and Administrators, and Accurately Evaluating Students’ Needs.
Click here to enter text.
3c. Facilitating students’ determination of eligibility for special education and subsequent development of the Individual Education Plan (I.E.P.)
Click here to enter text.
Domain 4 (Professional Responsibilities) Feedback
Click here to enter text.
Other Areas for Further Development
Click here to enter text.
Date of post conversation: Click here to enter text.
Psychologist Signature: ______________________________________________________________
Signature indicates only that the psychologist has received the formative feedback.
Administrator Signature: __________________________________________________________