Cleveland State University
Teacher as a Responsive, Reflective Professional: A Partner in Learning
College of Education and Human Services
Office of Field Services Language Arts Intern Field Experience Record and Evaluation Form
Intern:
Experience
(PR/ST):
School:
Semester
and Year:
/_
Grade Level(s)/
Subject:
Completed
by (print
name and
check role):
Supervisor
Mentor
CTE
*Supervisors Complete:
Date of
Initial Visit
/
/
Date of
Midterm
Triad
/
/
Date of
Final Triad
/
/
*Mentors complete the sections specific to the field; *If you have a split experience, leave the cumulative
column blank; supervisor will complete
Mentors Complete
7 week
15 week
Cumulative
Absences from the field
Tardies in the field
Missed/Late assignments in the field
Weak/Unacceptable assignments in the field
*Supervisors complete the sections specific to the seminar and the cumulative column. If the intern has a
split experience, complete the cumulative columns for both your section and the mentor’s section.
Supervisors Complete
7 week
15 week
Cumulative
Absences from seminar
Tardies in seminar
Missed/Late assignments in seminar
Weak/Unacceptable assignments in seminar
Rev Date: 03/14
Intern’s Name:
Supervisor’s Name:
Performance Levels: Exemplary (E)
Scores:
4
3.5
Proficient (P)
Emerging (M)
3
2.5
Unsatisfactory (U)
2
1
Not attempted
0
Average Domain Scores
Domain A. Organizing Content Knowledge for Student Learning
Average
7
A1.
A2.
A3.
A4.
A5.
15
Use of student background information for planning instruction (OSTP Standard 1)
Plans relate to intern’s knowledge of students.
Plans accommodate for needs of English language learners and students with exceptionalities.
Plans vary instruction based on students’ background.
Plans demonstrate cultural competence by incorporating instructional content, resources, and strategies that are responsive to
cultural, linguistic, and gender differences.
Instructional goals and objectives (OSTP Standard 2)
Plans establish clear goals.
Plans establish measurable objectives.
Goals and objectives relate to varied learning styles.
Goals and objectives establish appropriate expectations for all students.
Goals and objectives relate to Ohio Academic Content Standards and are aligned with school curriculum.
Content of instructional plans (OSTP Standard 2)
Plans demonstrate correct sequencing of subject matter.
Plans demonstrate accurate content knowledge.
Plans demonstrate cross-disciplinary connections where appropriate.
Structure of planned activities and materials (OSTP Standards 1.1, 4)
Structure of lesson is developmentally appropriate for students and subject matter.
Activities and materials match with identified instructional goals.
Activities and materials are appropriate for students’ diverse needs and characteristics.
Assessment (OSTP Standard 3)
Plan includes varied assessment strategies to measure the achievement of instructional goals and objectives.
Assessment strategies are appropriate for students.
Licensure Specific Items
A6.
Plans show intern selects resources for instruction such as textbooks, other print materials, videos, films,
records, and software, appropriate for supporting the teaching of ELA. (NCTE 4.1)
A7.
Plans show intern aligns curriculum goals and teaching strategies with the organization
of the classroom environment to promote whole-class, small group, and individual
instruction. (NCTE 4.2 )
A8.
Plans include formal and informal student assessment activities and instruments that
reflect alignment with local, state, and national ELA content standards. (NCTE 4.10 )
2
Rev Date: 03/14
Intern’s Name:
Supervisor’s Name:
Domain B. Enhancing the Learning Environment
B1.
B2.
B3.
B4.
B5.
Average
7
15
Fairness to students (OSTP Standard 5)
Intern establishes a climate of courtesy and respect
Intern makes eye contact with students.
Intern shows impartiality by involving all students.
Rapport with students (OSTP Standard 5)
Intern expresses interest in students and knows students’ names.
Intern shows enthusiasm and appropriate tone.
Intern establishes positive rapport with students.
Challenging expectations for learners (OSTP Standard 1)
Intern encourages students to ask questions. Intern
provides students with choices in learning. Intern
encourages students to pursue further learning.
Classroom management skills (OSTP Standard 5)
Intern states specific, appropriate expectations for classroom behavior and states reasons for expectations.
Intern applies rules consistently and fairly.
Intern maintains students’ attention throughout the lesson.
Intern promotes positive behavior.
Physical environment (OSTP Standard 5)
Intern maintains a safe learning environment.
Intern enhances student learning with bulletin boards/displays of student work.
Intern uses space and materials to vary physical environment to meet students’ needs and instructional goals.
3
Rev Date: 03/14
Intern’s Name:
Supervisor’s Name:
Domain C. Teaching for Student Learning
C1.
C2.
C3.
C4.
C5.
C6.
C7.
Average
7
15
Communicating goals and procedures (OSTP Standard 4)
Intern makes goals and objectives clear to students.
Intern makes instructional procedures clear to students.
Communicating content (OSTP Standards 2, 4)
Intern conveys content clearly and accurately.
Intern uses correct language, spelling, and syntax in verbal and written explanations of content.
Intern clarifies content for students having difficulty understanding.
Structure and sequence of instructional activities (OSTP Standard 4)
Intern uses lesson structure and sequence that is developmentally appropriate for students and subject matter.
Intern uses a variety of individual and collaborative learning activities to achieve learning goals.
Intern uses appropriate manipulatives and instructional materials to support student learning.
Intern uses appropriate available technology to support student learning.
Intern provides appropriate adaptations for English language learners and students with exceptionalities.
Extending student thinking (OSTP Standard 1, 4)
Intern structures specific learning activities that encourage students to extend their thinking.
Intern recognizes and uses opportunities to help students extend their thinking.
Intern uses questioning and other interaction strategies to foster students’ understanding and to stimulate creative and
critical thinking.
Intern allows sufficient wait-time for student response to questions.
Assessing student understanding (OSTP Standard 3)
Intern uses questioning and a variety of other appropriate assessment strategies to gauge student learning.
Intern correctly interprets students’ verbal and non-verbal cues for levels of understanding.
Plan includes varied assessment strategies to measure the achievement of instructional goals and objectives.
Assessment strategies are appropriate for students.
Use of assessment (OSTP Standards 3, 4)
Intern keeps written documentation of assessments to track student learning over time.
Intern adjusts instruction/activities based on formative assessment and uses teachable moments to meet students’ needs.
Intern monitors students and gives them substantive feedback.
Intern uses evaluation results in planning future instruction.
Use of time (OSTP Standard 5)
Instructional materials are ready prior to the lesson.
Intern sues routines and procedures to maximize instructional time.
Intern paces the lesson appropriately for the students and content.
Intern makes smooth transitions between instructional activities to maximize instructional time.
Licensure Specific Items
C8.
Intern selects and uses instructional resources including print and non-print media as well as technology
appropriate for supporting the teaching of English Language Arts. (NCTE 4.1 )
C9. Intern aligns curriculum goals and teaching strategies with the organization of the classroom environment
to promote whole-class, small group, and individual instruction. (NCTE 4.2 )
C10. Intern uses interdisciplinary teaching strategies and materials to build cross-disciplinary connections and
help students apply ELA knowledge and skills. (NCTE 4.3 )
C11. Intern uses and models respectful, appropriate, and effective verbal and non-verbal communication
techniques to create and sustain learning environments that support individual differences of ethnicity, race,
language, culture, gender and ability. (NCTE 4.4 )
C12.
Intern engages students in meaningful discussions for the purposes of interpreting and evaluating ideas
presented through oral, written, and/or visual forms. (NCTE 4.5 )
C13.
Intern engages students in the critical analysis and evaluation of different media and communication
technologies. (NCTE 4.6 )
Intern
engages students in learning experiences that consistently emphasize varied uses and purposes of
C14.
language in communication. (NCTE 4.7 )
4
Rev Date: 03/14
Intern’s Name:
Supervisor’s Name:
C15.
Intern engages students in making meaning of texts through personal response. (NCTE 4.8 )
C16.
Intern demonstrates that students can select appropriate reading strategies that permit access to, and
understanding of, a wide range of print and non-print texts. (NCTE 4.9 )
C17.
Intern employs standards-aligned formal and informal assessments and ensures that students are aware of
the criteria used to evaluate processes and products. (NCTE 4.10 )
C18.
Intern documents student learning of ELA in ways that provide students, parents, administrators, and other
school personnel with an accurate understanding of individual progress. (NCTE 4.10 )
C19.
Intern makes meaningful connections between the ELA curriculum and developments in culture, society,
and education. (NCTE 2.5 )
C20. Intern engages students in activities that demonstrate the role of arts and humanities in learning. (NCTE
2.6 )
Domain D. Professionalism
Average
7
D1.
D2.
D3.
D4.
D5.
15
Reflection and professional development (OSTP Standard 7)
Intern uses self-reflection to recognize and correct weaknesses.
Intern reflects on student achievement of the learning goals.
Intern uses feedback from prior observations to improve instruction.
Completion of work in the field (OSTP Standard 7)
Intern follows school policies to maintain accurate student records and grades.
Intern performs assigned professional duties in the classroom.
Intern demonstrates initiative in getting involved in the classroom and working with the mentor.
Collaboration (OSTP Standard 6)
Intern requests professional assistance from appropriate sources.
Intern establishes professional rapport with mentor and supervisor.
Intern maintains appropriate oral and written communication with families.
Professional habits in the field (OSTP Standard 7)
Intern follows school policies.
Intern displays dispositions listed on the CSU List of Student Dispositions (including punctuality, attendance, and appropriate
appearance) in the field.
Intern participates in additional contractual teacher obligations as required by the experience (planning meetin gs, faculty
meetings, parent-teacher conferences, professional development activities, school functions).
Intern uses appropriate vocabulary and correct grammar/punctuation in verbal and written communication.
Professional habits in seminar (OSTP Standard 7)
Intern displays dispositions listed on the CSU List of Student Dispositions (including punctuality, attendance, and active
participation) in the seminar and with the supervisor.
Intern completes all assignments and submits written work, including portfolio artifacts, in a timely fashion as assigned by
supervisor, seminar leader, or mentor teacher.
Intern uses appropriate vocabulary and correct grammar/punctuation in verbal and written communication.
5
Rev Date: 03/14
Intern’s Name:
Supervisor’s Name:
Mentor teachers completing this form: Please note that all interns will receive two mentor observations unless
the mentor teacher is a CTE.
Please record the averages of each domain in the boxes below.
The third box requires an average of domains A-C.
Observations
Observations
Domain
A
Date
Domain
B
Domain
C
A-C
Average
Domain
D
The intern and observer initial to
indicate receipt of observation
write-up
#1
Intern:
Observer:
#2
Intern:
Observer:
#3*
CTE’s
only
Intern:
Observer:
Intern:
Observer:
#4*
CTE’s only
This section is to be completed for the 7-week Triad Conference only.
Midterm Evaluation (student teaching and practicum interns get a numeric grade at midterm):
Grade (circle one): A (4.0)
A- (3.7)
B+ (3.3)
B (3.0)
B-(2.7)
Strengths
C+ (2.3)
C (2.0)
D(1.0)
F(0.0)
Goals for Second Half of Semester
Signatures for Midterm Evaluation (7-week)
Supervisor
Date
Mentor Teacher
Date
Intern
Date
6
Rev Date: 03/14
Intern’s Name:
Supervisor’s Name:
This section is to be completed for the 15-week Triad Conference only
Final Evaluation (practicum interns receive a grade; student teaching interns are satisfactory or unsatisfactory):
Practicum (circle one): A (4.0)
Student Teaching (circle one):
A- (3.7)
B+ (3.3)
B (3.0)
B- (2.7)
C+ (2.3)
Satisfactory
C (2.0)
D (1.0)
F (0.0)
Unsatisfactory
Supervisor (or CTE) will assign final grade based on mentor teacher and supervisor observations, seminar assignments, portfolio
artifacts, and professionalism.
Strengths
Areas for Continued Professional Growth
Signatures for Final Evaluation (15-week triad)
Supervisor
Date
Mentor Teacher
Date
Intern
Date
------------------------------------------------------------------------------------------------------------------- -----------------------------------------------
Honors and Recognition
****Promising Practicum Intern****
**Initial Check here if nominated for Promising Practicum Intern:
Mentor Teacher
_
Supervisor
****Outstanding Student Teacher****
**Initial here if nominated for Outstanding Student Teacher (top 20%): Mentor Teacher
_
Supervisor
7
Rev Date: 03/14