Cleveland State University
Teacher as a Responsive, Reflective Professional: A Partner in Learning
College of Education and Human Services
Office of Field Services –Physical Education Intern Field Experience Record and Evaluation Form
Intern:
Experience
(PR/ST):
School:
Grade Level(s)/
Subject:
Completed
by
(print name
and check
role):
Semester
and Year:
___ 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: ________________________________________
Performance Levels: Exemplary (E)
Scores:
4
3.5
Supervisor’s Name: ________________________________
Proficient (P)
Emerging (M)
3
2.5
2
Unsatisfactory (U)
1
Average Domain Scores
Domain A. Organizing Content Knowledge for Student Learning
Not attempted
0
Average
7
A1.
A2.
A3.
A4.
A5.
Use of student background information for planning instruction (OSTP Standard 1),(NASPE 3.4, 3.5)
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),(NASPE 3.2)
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 3), (NASPE 3.6)
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 Standard 1.1, 4), (NASPE 3.3, 3.4)
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),(NASPE 5.1)
Plan includes varied assessment strategies to measure the achievement of instructional goals and objectives.
Assessment strategies are appropriate for students.
Licensure Specific Items
A6.
Planning and Implementation (NASPE 3.1, 3.2, 3.3, 3.5)
Physical education teacher candidates plan and implement developmentally appropriate learning
experiences aligned with local, state and national standards to address the diverse needs of all students.
A7.
Impact on Student Learning (NASPE 5.1, 5.2)
Physical education teacher candidates utilize assessments and reflection to foster student learning and
to inform instructional decisions
Domain B. Enhancing the Learning Environment
B1.
B2.
B3.
15
Fairness to students (OSTP Standard 5) ,(NASPE 4.4, 4.5)
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),(NASPE 4.6)
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), (NASPE 4.1, 4.6)
Intern encourages students to ask questions.
Intern provides students with choices in learning.
Intern encourages students to pursue further learning.
2
Average
7
15
Average
7
15
Rev Date: 03/14
Intern’s Name: ________________________________________
B4.
B5.
Supervisor’s Name: ________________________________
Classroom management skills (OSTP Standard 5),(NASPE 4.1, 4.2, 4.3, 4.5)
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), (NASPE 4.5)
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.
Licensure Specific Items
B6.
Instructional Delivery and Management (NASPE 4.1, 4.2, 4.3, 4.4, 4.5, 4.6)
Physical education teacher candidates use effective communication and pedagogical skills and
strategies to enhance student engagement and learning.
Domain C. Teaching for Student Learning
C1.
C2.
C3.
C4.
C5.
C6.
C7.
Average
7
15
Communicating goals and procedures (OSTP Standard 4), (NASPE 3.2)
Intern makes goals and objectives clear to students.
Intern makes instructional procedures clear to students.
Communicating content (OSTP Standards 2, 4), (NASPE 4.1, 4.3)
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), (NASPE 3.6, 3.7, 3.5)
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 Standards 1, 4), (NASPE 4.2, 4.1, 4.6)
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/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), (NASPE 5.1, 5.2)
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 Standard 3, 4),(NASPE 5.1, 5.2)
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), (NASPE 4.5)
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.
Average
7
15
Scientific and Theoretical Knowledge (NASPE 1.1, 1.3, 1.5)
3
Average
7
15
Rev Date: 03/14
Intern’s Name: ________________________________________
C9.
Supervisor’s Name: ________________________________
Physical education teacher candidates know and apply discipline-specific scientific and theoretical
concepts critical to the development of physically educated individuals.
Skill-Based/ Fitness-Based Competence (NASPE 2.1, 2.3)
Physical education teacher candidates are physically educated individuals with the knowledge and skills
necessary to demonstrate competent movement performance and health-enhancing fitness as delineated in
NASPE's K-12 Standards.
Domain D. Professionalism
D1.
D2.
D3.
D4.
D5.
D6.
Average
7
15
Reflection and professional development (OSTP Standard 7),(NASPE 5.3)
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), (NASPE 6.2, 6.3)
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), (NASPE 6.1, 6.2, 6.3, 6.4)
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), (NASPE 6.3, 6.2, 6.4)
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 meetings, 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), (NASPE 6.1, 6.2, 6.4)
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.
Licensure Specific Items
Professionalism (NASPE 6.1, 6.2, 6.3, 6.4)
Physical Education teacher candidates demonstrate dispositions essential to becoming effective
professionals.
4
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
Date
Domain
A
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: _________
#4*
CTE’s only
Intern: ________ Observer: _________
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 _____________________
5
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)
Satisfactory
C+ (2.3)
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
6
________
Rev Date: 03/14