Clinical/Internship Experiences Dispositions Evaluation (Form M)
To Be Completed by Cooperating Teacher/University Supervisor
Candidate/Intern:
Course:
School & Grade Level:
Semester:
Please evaluate the candidate on the following characteristics and check whether the candidate is at the Target, Acceptable, or Unacceptable level.
Please provide evidence of your evaluations.
Elements
Attitude
Emotional maturity, Initiative,
Responsiveness to professional
feedback (receptivity and
responsiveness)
Comments:
Revised 4/29/11
Unacceptable/Needs
Improvement
1-2
Acceptable
3-4
vents frustration
inappropriately, needs step-bystep instruction, rejects/ignores
ideas and suggestions,
excessively negative or
inappropriately responds to
other students, blames others
for problems
frustration sometimes
interferes with classroom
performance, operates
independently with direction,
occasionally accepts ideas and
suggestions, demonstrates
minimal responsiveness
Target
5
handles frustration
appropriately, demonstrates
independence and initiative,
demonstrates receptivity to
constructive feedback, listens
and responds thoughtfully to
feedback
Rating
Elements
Diversity
Values multiple aspects of
diversity: respects children and
adults of various cultural
backgrounds, ethnicities, religions,
sexual orientations, social classes,
abilities and political beliefs
Unacceptable/Needs
Improvement
1-2
Acceptable
3-4
Target
5
Demonstrates no respect for
cultural, racial, gender and/or
religious differences;
Demonstrates partiality toward
certain groups
Demonstrates respect for
cultural, racial, and religious
differences by openly
discussing, reading, and
displaying materials that
represent the different cultures,
races, genders, and/or religions
periodically; Shows no
partiality toward certain groups
of students
Treats all students, teachers,
and parents with respect;
Acknowledges and celebrates
various cultures, races, and
religions by openly discussing,
reading stories, and displaying
pictures that represent different
cultures, races, genders, and/or
religions throughout the
clinical experience.
Negative attitude; Displays
little interest in students,
content, and teaching
Positive most of the time;
Displays interest in students,
content, and teaching
Always positive; Helps
students outside of class time;
Searches for innovative
methods; Shares ideas;
Participates in school activities
outside of class time
Dresses unprofessionally;
Does not observe dress code;
Displays no care in personal
hygiene
Generally dresses
professionally and observes
dress codes; Exhibits care in
personal hygiene
Always dresses professionally
at school and at extracurricular
events; Exhibits care in
personal hygiene
Comments:
Enthusiasm
Demonstrates a positive interest and
commitment to student learning and
teaching
Comments:
Personal Appearance
Demonstrates attire that is in
alignment with the suggested SOE
dress code
Comments:
Revised 4/29/11
Rating
Elements
Professionalism
Demonstrates adherence to the
standards of ethical conduct
including academic honesty and
confidentiality
Unacceptable/Needs
Improvement
1-2
Acceptable
3-4
Target
5
Gossips; Does not keep
information confidential;
Dishonest
Observes confidentiality;
Demonstrates honesty and
integrity
Observes confidentiality;
Demonstrates honesty,
integrity, and willingness to
accept responsibilities beyond
the classroom (e.g., athletics,
school committees, clubs);
Enthusiastic about the teaching
profession; Serves as a model
of behavior expected of an
educator;
Arrives late to school or class
or leaves early
Arrives and leaves at assigned
times
Arrives early and stays late as
necessary
Does not interact well with
students, parents, faculty,
and/or staff
Interacts positively with
students, parents, faculty, and
staff
Interacts positively with
students, faculty, staff, and
parents; Initiates contributions
to class, school activities or
parent conferences which are
well received
Comments:
Punctuality
Meets all time expectations
Comments:
Rapport
Demonstrates an ability to
effectively communicate and
interact with others
Comments:
Revised 4/29/11
Rating
Elements
Reliability
Recognizes and fulfills all
professional expectations
Unacceptable/Needs
Improvement
1-2
Acceptable
3-4
Target
5
Tasks are not completed within
a prescribed time
Completes tasks within
prescribed times
Completes all tasks within
prescribed times
Displays a lack of concern for
students’ abilities and/or needs
Exhibits care and concern for
students’ abilities and needs
Exhibits care and concern for
students’ abilities and needs;
Spends additional time (after
school, after class) with
students who need help; Seeks
information and advice from
parents and staff to improve
students’ education
Comments:
Sensitivity
Demonstrates empathy and
understanding for others
Comments:
Teacher Comments:
*Please describe your concern(s) so that it may be addressed. Your suggestions to assist the candidate are welcomed.
Signature of Cooperating Teacher/University Supervisor
Revised 4/29/11
Date
School
Rating