1
USCA Aiken School of Education
Intern Final Grade Report/Verification (Form B)
Intern Name
University
Supervisor
Name
Cooperating
Teacher Name
Date
School Name
Grade/
Subject
APS
Acceptable
Column A
Unacceptable
Column B
Domain Total (Target
+ Acceptable)
Domain 1
Planning
1.A
1.B
1.C
1.D
1.E
2.A
2.B
2.C
3.A
3.B
3.C
4.A
4.B
4.C
5.A
5.B
5.C
6.A
6.B
6.C
7.A
7.B
7.C
8.A
8.B
8.C
9.A
9.B
9.C
10.A
10.B
10.C
10.D
10.E
SOE 1
SOE 2
Totals
(Total Target + Total Acceptable)
36
Target
Domain 2
Instruction
Out of 11
Domain 3
Classroom
Environment
Out of 12
Domain 4
Professiona
lism
Out of 6
Out of 5
x 100 =
2
Possible Points
Total Points
(Column C)
Course Requirements Evaluation
Contextual Factors (TWS 1)
Long Range Plan (Semester Goals and Management Plan)
All Learning Goals for 2-weeks of full-time teaching (TWS 2)
Assessment Plan (TWS 3)
Design for Instruction (TWS 4)
 Lesson Plans
 Activity-based Experiences
 Appropriate Use of Technology
Instructional Decision-Making (TWS 5)
Analysis of Student Learning (TWS 6) / Develop and Administer Assessments throughout Internship and Provide Appropriate
Evaluations of Assessments
Reflection and Self-Evaluation (TWS 7)
Diversity Artifact
Parent/Teacher Conference
Effective Interpersonal Communication Skills
6 University Supervisor Observations (including Mid-Term & Final Observations)
TOTAL FOR COLUMN C
I.
Cooperating Teacher’s Recommendation:
Recommended
Recommend w/Reservations
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
IV. University Supervisor/Cooperating Teacher Overall Evaluation Judgment:: 40% of
Column A
0-5
0-10
0-5
0-5
0-5
0-5
0-25
0-100
Not Recommended
II. Cooperating Teacher and University Supervisor Time Verification:
Initials verify the above named student has met the State mandated requirements of 60 full days of Internship.
III. Please verify the following:
Candidate has rated a Target or Acceptable on 10 of 11 Key Elements in Domain 1
Candidate has rated a Target or Acceptable on 11 of 12 Key Elements in Domain 2
Candidate has rated a Target or Acceptable on 5 of 6 Key Elements in Domain 3
Candidate has rated a Target or Acceptable on 4 of 5 Key Elements in Domain 4
Candidate has rated a Target or Acceptable on the SOE Oral Communications
Candidate has rated a Target or Acceptable on the SOE Written Communications
Candidate assumed full responsibility for no less than two weeks
0–5
0–5
0–5
0-5
0 – 20
Coop.Teacher
Univ Supervisor
 No
 No
 No
 No
 No
 No
 No
+ 60% of
=
Column C
Total Score
Required parameters are missing or Recomme
incorrect. Required parameters are missing or Recomme
incorrect. Required
are missing
or Not
incorrect.
FINALparameters
LETTER GRADE
*
nded
nded with
Recomme
Reservatio
n
Signature of University Supervisor
Signature of Cooperating Teacher
Signature of Intern
nded
3
*Interns must have at least 30 of 34 APS(missing only 1 element in each domain) rated competent and a C or higher in the internship in order to be recommended for initial
teacher certification.
Evaluation and Grading Scale
Final Evaluation
ADEPT/SAFE-T
Performance Standards
Internship Course Assignments:
Required Activities
40%
Final Grading Scale
A 95 - 100 B+ 90 - 94
B 85 - 89
C+ 80 - 84
C 75 - 79
D 70 – 74
F 69 and below
60%
The final course grade is based on demonstration of competency in the 4 ADEPT/SAFE-T
Domains and written and verbal communication along with the successful fulfillment of the
course assignments.
One point is given for each ADEPT/SAFE-T Performance Standard Key Element that has been
identified as competent and one point is given for both verbal and written communication. A
total of 36 points are possible in Column A. The total points given should be divided by 36 (the
total possible points). This number should then be multiplied by 100. Then, 40% of this number
is the final total given for Column A (total number for Column A can not exceed 40 points).
Therefore, forty percent of the final grade is based on the ADEPT/SAFE-T Performance
Standards and written and verbal communication.
Sixty percent (60%) of the final grade is based on the total points earned from the Internship
Course Assignments: Required Activities. The points given in Column C should be totaled, and
60% of this number is the final total for Column C.
In order to be recommended for initial teacher certification, interns must have a grade of C
or higher in internship, an Acceptable or Target on at least 30 of the 34 Key Elements, and
an Acceptable or Target in written and verbal communication skills. A candidate can only
miss one Key Element per Domain. It is possible to earn Targets or Acceptables in all Key
Elements, yet still not be recommended for certification because 60% of the grade is from
the internship course assignments.
Example:
Intern earns competent on 9 out of 10 PDs and earns competent on verbal and written
communication (2 points) = 11 earned points
Score = 33/36 =.92
.92 x 100 = 92
.40 (40%) x 92 =36.8 points
36.8 points is the total for Column A
Intern receives 70 points on the Internship Course Requirements
Score = 70
.60 (60%) x 70 = 42 points
42 points is the total for Column C
Total Points = 36.8 + 42 = 78.8 = C. Intern would be recommended for certification with
reservations.
Interns would not receive credit for the internship nor be recommended for certification with a
grade of a D or F.
The University Supervisor is responsible for assigning the final grade for the Internship. To
receive a final grade all assignments must be completed to the satisfaction of the University
Supervisor.