School-Based Internship Supervisory Materials
Part 1: Information
Contents
Responsibilities and Expectations ..................................................................................................... 2
Responsibilities and Expectations of the Student Intern: ............................................................................. 2
Responsibilities and Expectations of the School-Based Internship Supervisor ........................................... 3
Suggestions for Working with a Student Clinician ........................................................................... 4
A Week-by-Week Plan ................................................................................................................................ 5
Feedback Example: ...................................................................................................................................... 7
Documenting Clinical Clock Hours ................................................................................................... 8
Student Evaluation ........................................................................................................................... 13
Example of a completed PDE Form 430A ................................................................................................. 13
Example of a completed PDE 430 Evaluation ........................................................................................... 17
On-Site Visit Information ................................................................................................................ 22
PA Code of Professional Practice and Conduct for Educators .................................................................. 24
Responsibilities and Expectations
Greetings from Edinboro University’s Master of Arts in Speech-Language Pathology Program.
We are both delighted and appreciative that you are willing to mentor our students. This full-time
15-week placement allows students the opportunity to develop the essential skills and knowledge
for future employment in a school-based setting. Much of what is learned as an intern will be used
for a lifetime as a school-based professional. If you have any questions at any time, please feel
free to contact me.
Susan Hegel, Ph.D., CCC-SLP
Coordinator of School-Based Internships
Speech, Language and Hearing Department
215 Scotland Road, Room 241
Edinboro University
Edinboro, PA 16444
shegel@edinboro.edu
Office: 814-732-2192
Cell: 814-860-1178
FAX: 814-732-2612
Responsibilities and Expectations of the Student Intern:
The student intern will follow the PA Code of Professional Practice and Conduct for Educators. It
is the responsibility of the student intern to communicate professionally with his/her supervisor
and building staff before, during and after the placement. Interns follow the placement site
calendar, not the university calendar, and student interns will abide by all district rules while
placed. It is the student intern’s responsibility to obtain diagnostic and treatment hours necessary
to complete this placement and to graduate.
During the placement interns are expected to earn at least 150 clinical clock hours. To graduate,
students must have 400 clinical clock hours and must meet ASHA’s minimum requirements of:

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20 clinical clock hours of pediatric (motor) speech diagnostics
Articulation, phonology if specific sound recognition/production are required (i.e.,
spelling), fluency, or swallowing
20 clinical clock hours of pediatric language diagnostics
Receptive, expressive language, phonology if metacognitive tasks, auditory processing,
communication competence (social language)
20 clinical clock hours of pediatric (motor) speech therapy
20 clinical clock hours of pediatric language therapy
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Responsibilities and Expectations of the School-Based Internship Supervisor
It is the responsibility of the supervisor to keep his/her CCC status current for the duration of the
internship placement. If the supervisor’s ASHA CCC status is not current during the placement,
clinical clock hours supervised during the non-certified time period are not valid. Please pay your
ASHA dues for next year before January 1st and fax me a copy of your ASHA membership card
when received. Our FAX is 814-732-2612.
Supervisors are to develop the student’s clinical skills and competence by gradually increasing the
student intern’s responsibilities. (See Suggestions for Working with a Student Intern for a weekby-week plan.)
Supervisors will supervise at least 25% of all treatment sessions and 50% of each and every
diagnostic session as specified by the American Speech-Language-Hearing Association (ASHA)
and the Pennsylvania Licensure Board.
The CCC-SLP supervisor must be in the building if the intern is providing any form of clinical
services. This is an ASHA requirement. Your intern cannot provide services when you are home
ill, at a conference, or at another building unless there is another CCC-SLP in the same building
as the intern. Therefore, it is recommended that an alternative activity plan be designed for use on
those days when the CCC-SLP supervisor may be out of the building. For example, the intern
could work on files, write ER or IEP reports, provide help (not treatment) in any classroom, or go
to another building and work with the CCC-SLP there. The intern may not provide speechlanguage services unless a CCC-SLP is physically in the building.
The supervisor will provide on-going feedback through session reviews, discussion, and
suggestions to help the student develop better clinical skills.
Formal written evaluation will include completion of the mandated PDE form 430 at mid-term
(approximately the 7th week) and final evaluation (during the 15th week). Signed copies are to be
sent to the EUP school-based coordinator as these become part of the student’s PDE Certification
Packet.
All supervisors, even those in states other than PA, are to use the PDE 430 and 430A forms at the
midterm and final evaluation. These forms are required for Pennsylvania Department of Education
certification.
Again, if you have any questions, please contact me at shegel@edinboro.edu; 814-732-2192 work;
or 814-860-1178 cell
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Suggestions for Working with a Student Clinician
You will have your student clinician with you every day of the week for the next 15 weeks. If the
experience is a positive one, the time will fly by. However, if the experience is filled with
frustration or tension for either of you, those 15 weeks could seem like forever. In an effort to
make this experience as enjoyable as possible for all involved, here are some suggestions:
Please remember that your student clinician is just that, a student. Remember what it feels like to
be the neophyte? She/he is not a competent SLP ready to assume your job. Too much information
presented too quickly will create an unhappy overwhelmed intern. Your job is to gently guide the
student through the variety of responsibilities and demands faced by a school-based clinician.
Our school-based students have been very busy earning adult clinical clock hours since we assured
them that they would gain their child-based hours in the schools. As a result, the student assigned
to you may have minimal experience (less than 10 clinical clock hours) working with children.
Please talk with your student about his/her child-based experience so expectations of current
clinical competency are realistic.
Clinically, we offer individual treatment sessions at Leader Clinic. Many of our students have
never had the opportunity or expectation to plan and execute group treatment or whole-classroom
lessons. Coping with the therapeutic and behavioral needs of multiple children will be a new
experience for most of our students. Your student intern will need guidance in both planning and
in delivery of group treatment.
Assessment principles and materials are presented and discussed in class. Frequently, students will
practice test administration using peers or children with normally developing language. However,
administering assessments to a child with known language impairment can be a very different
experience. Permitting the student to review the manual for new or unfamiliar tests and/or
watching you administer tests would be helpful. Scoring tests may also be a slow and confusing
task initially. Please be patient. Your student clinician will get faster with experience and
guidance.
A weekly meeting reviewing issues of the past week has been highly valued by student clinicians.
This should cover what went particularly well during the week and what needs improvement. A
sample form follows. Use it if it fits your style. Whatever your method, I recommend that you keep
a copy of your supervisory notes, as they are very helpful when writing a letter of reference.
At our on-campus clinic students are assigned one (1) to three (3) clients per term.
Understandably, a caseload of 60 plus can be terrifying. Therefore, we recommend a gradual
transition of your caseload so the student is not overwhelmed. A suggested plan is below. Feel
free to adjust it as needed:
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A Week-by-Week Plan
Week 1: Student clinician observes you do treatment. This allows the student to get to
know your caseload, see what materials you use, and how you use select, design, and
deliver treatment.
Week 2: Target approximately three or four groups of “basic/traditional” clients for initial
transfer. Team-teach from your lesson plans and discuss ideas that will facilitate a smooth
transition of these groups from your caseload to the intern’s caseload.
If possible, discuss and plan an upcoming evaluation with your intern. The student is
expected to review all materials before he/she administers any assessment.
Week 3: During week three, the clinician does the treatment planning. Team-teach from
the student’s plans with suggestions/corrections as needed. Diagnostic work continues if
opportunities are available.
Week 4: Student assumes responsibilities for both planning and therapy delivery for the
identified groups. Identify other clients for team-teaching this week (in addition to students
he/she is already working with).
Week 5: Continue the team-teaching with the newly identified students with your intern
planning and leading the sessions.
Week 6: Student intern has responsibility for all of the groups team-taught.
Week 7: Student clinician should have approximately half of your caseload by now. You
will need to schedule time for a midterm review this week. Please complete the
MANDATED Pennsylvania Statewide Evaluation Form for Student Professional
Knowledge and Practice (PDE 430 and PDE 430A forms). These forms are below. Please
save the evaluation forms to your desktop and work from there. Additional instructions
and examples for both forms are below.
Weeks 8-9: Let the student continue with half of your caseload and diagnostic work if
possible for a week or two. This provides a chance for depth, variety, and knowledge of
various clinical skills to expand.
Week 10:
Transfer another set of clients to the student clinician so he/she has about
three-fourths of your caseload.
Week 11:
No new responsibilities this week.
Week 12:
If there are any other clients who would be appropriate to transfer to the
student clinician, do so this week.
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Weeks 13-14: Student clinician carries the majority of the caseload plus diagnostic
responsibilities if the opportunity exists.
Week 15:
Last week so team-teach all lessons with the student clinician transitioning
clients back to you. Student should be able to explain what growth each client has made
during the internship period and what the current objectives of treatment are for the
remainder of the school year.
Final Review: Please schedule time for a final review this week. Complete the
MANDATED Pennsylvania Statewide Evaluation Form for Student Professional
Knowledge and Practice (PDE 430 and PDE 430A forms) AND the PDE Stage 4
Competency checklist. These forms are below. Please save the evaluation forms to your
desktop and work from there. Additional instructions and examples for both forms are
below. The School of Education has requested two separate documents for Midterm and
Final evaluations so if you have supervised before and used different colored ink to
indicate Midterm and Final comments, this is no longer an option. 
Please feel free to add in additional responsibilities such as bulletin boards, meetings, various
building duties, etc. All of these activities are part of the school-based SLP’s professional life.
Your intern will rise to the challenge!
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Feedback Example:
DAILY/WEEKLY STUDENT TEACHING ANALYSIS
Student Teacher: Stew Dent
School placement supervisor: Sue Pervisor
Date: 3/5/07
1) Your best teaching skills were demonstrated with the following students/in the
following areas:
Good job this morning working with MS and CJ. CJ has a lot of difficulty using vocabulary
words in sentences and you did a good job probing. This helps her to generate sentences.
Good job keeping everyone on task during the 1st group at Bainbridge. Having four students in
a session can really be challenging! Good job keeping data today also. It can get rather tricky
sometimes trying to keep data and administer therapy at the same time.
2) Areas that need improvement or general suggestions for the following day/week:
At Bainbridge it is important to make sure you are organized and ready to go prior to getting to
the school. There is not a lot of prep time when we get there so you need to have everything
for each session ready to pull out right away. It is also important to pay attention to the clock
and be aware of when sessions are over and new sessions begin. If you go over time in one
session you might end up cutting off time for another session. Feel free to keep the therapy
schedule right next to you to help remind you of when sessions start and end and use my timer
if helpful.
Being able to determine sounds in error is important and you’re doing that. In addition, I want
you to listen for and identify the error itself—is it a substitution? If so, of which sound? Is it a
distortion, an omission? You need to know what the child/client is doing before asking him/her
to change the production. Your ear is getting better—keep working on this!
3) Specific goals for the next day/week are:
Write evaluation report for SH for Wednesday. Tomorrow I will give back the evaluation report
for RM w/ feedback so you can go back and make corrections. Continue to plan sessions for the
morning groups on M/W and afternoon groups on T/Th. Fill out self-evaluation sheet for today.
___________________________
School placement supervisor
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Documenting Clinical Clock Hours
Using Typhon HealthCare Solutions
Access will be available as of December lst
Step l: Go to: https://www.typhongroup.net/edinboro/
You will see this:
Notice that the EUP Account
Number of 9156 is already here.
If blank for any reason, just add
that code.
Enter your email (the one I
have been using to contact
you) and the common initial
password EUP16444 (our zip
code). Click on the Red Log
In button
Step 2: You will now see the Main Menu Page (MMP). The link on the far right will allow you to
change your password once you are in the system.
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Step 3: The second cluster on the list above (circled) includes these:
DETAILS BY CASE
Case Log Details (Individual)
Case Log Details (Bulk Export)
Case Log Highlights (by Day/Week/Month) click on this one
Step 4: CASE LOG HIGHLIGHTS
You will see:
Your student’s name should be
here.
Click on [Today] and the top box to
show this week’s logs.
CASE LOG HIGHLIGHTS
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In the Student box, your intern’s name should be showing. If not, find your student intern
on the drop down menu
In the Date of Case Logs click on the blue TODAY link below the drop down box and
then check the first box the Show entire WEEK of logs…
Click the Apply Filters button
Here is an example of what this will look like after clicking on the GREEN Apply Filters
button.
Doe, Jane
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There are seven (7) fields (see stars!) in Case Log Highlights. Moving from left to right…
1. Status: When the student enters case data (anything about a client), the status will initially show as
PENDING. The supervisor (you) will review each entry and if correct, change the status to
Approved. You can do this entry-by-entry or if all are fine, change the top box to Approved and all
will change. If NOT OK, select NOT APPROVED and then enter a message (see below) and an
email will automatically be sent to the student about that entry. The student will make changes and
then the entry will repost with a PENDING status again awaiting your approval.
2. Date: This area lists all of the cases/patients seen on a specific date. Additional information about
date codes is listed below.
3. Site: This is your location. If the student will be working in several schools with you, I have listed
the school district as the site rather than multiple buildings. If you have one building or your school
building was previously on the list, it is listed as a specific building. Either method works as the
student intern is linked to you as the supervisor, not the placement site.
4. Age/Gender: Student selects these as well as the type of interaction from a pull-down menu. If
the student is seeing ONE student from a group (Dx. work perhaps?) while you work with the rest
of the group, the student should enter that interaction as an individual interaction. Interns should
NOT enter full group time for each student (e.g., 30 minutes three times for a total of 90 minutes
for a 30-minute group with three children).
5. Patient Time: Student enters the amount of time in minutes that were spent with the client/group.
6. Clinical Supervisor Consult Time: This is the time BEFORE/AFTER the session spent
discussing the client and/or session with the intern. This is not your direct supervision time but
your “teaching” time.
7. Custom Fill-in Questions. This area is the most important field as it shows the specific type of
service provided and the amount of supervision provided. Students will document either treatment
or diagnostics (or both as in the example above) and the type of disorder/therapy provided. In
addition, the student intern will document your supervision minutes in this area. In my mind this is
a flaw in the system but we as supervisors do NOT enter our supervision minutes, only students are
approved to enter data. We simply approve it. So check—was it treatment? Was it articulation
treatment? Did you supervise for the 5 minutes documented or was it 25 minutes? If all is OK as
posted, then “approve” this entry over in the STATUS field on the far left. In the Jane Doe example
above, Jane provided 30 minutes of Dx. and 30 minutes of Tx. both focused on
Receptive/Expressive Language. I observed all 30 minutes of her Dx. work but did not observe any
of her treatment on this particular date. This is fine as ASHA mandates that at least 50% of each
and every Dx. event be observed (so I was required to watch at least 15 minutes) and 25% of total
therapy for the client. This isn’t required to be by session so I could observe 100% of every fourth
session or 50% of every other session…any combination as long as it totals 25% of the therapy this
client receives.
If info documented by the student is not OK…..Click on the blue Case ID number in the DATE
Field. The link will open the case file and it will look like this:
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Note the Edit Case Status/Comments link in the upper left corner of the page (red circle). Click on
this and you will get a comment box. Post comments for the student here and if appropriate, change
approval status here. “Approved” closes and locks that post, “Pending” leaves it open for future action
but students are not prompted to read any messages from you; “NOT Approved” automatically sends
the student an email with your message. Feel free to use the NOT Approved to assure that students get
your feedback. You can change the status to Approved after the student has adjusted the data in that
case log.
If desired, students can post notes in this box as well—a quick way to summarize session goals: for
example: Dx. with TOLD-P4 Rel. Voc only + review and use of science vocab. This makes it easy to
see what was done without opening each and every case log.
Please visit Case Log Highlights on Typhon daily, or at least weekly, to verify student hours. Please
contact me (shegel@edinboro.edu; 814-732-2192 work; 814-860-1178 cell) if you have any questions—
I’m happy to walk you through various steps or help in any way.
There is another section of Typhon that may be interest to you. This is the Time Log (first link in the Time
Reports). Here students document their daily “shift time” which includes time spent with patients, time
spent in consultation with supervisors, and any additional time spent in preparation. Supervisors are not
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required (or allowed) to approve these hours but please review this area occasionally to be sure that students
note in-service events and/or AAC programming time that can’t be documented as clinical clock hours. If
students are at school for eight plus hours a day but minimal clinical clock hours being earned, this is a
problem. Please do not let them “coast” once their minimum 20 hours (80 total) in each pediatric area are
met. They are to provide therapy and diagnostic services for your caseload for the duration of the placement
with the assumption that they will be a school-based clinician in the future. With 400 clinical clock hours
mandated to graduate, they need every hour they can earn!
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Student Evaluation
Students are evaluated twice during the placement using the Pennsylvania Statewide Evaluation
Form for Student Professional Knowledge and Practice (PDE 430 and PDE 430A forms). These
documents are part the PDE application for school-based certification. The final page will need
signatures so send that separately if you do not have a fax or scan option. These forms are closely
aligned with each other and are posted separately for easy downloading to your desktop with a
completed example provided of each. The PDE 430A is a chart where students and supervisor can
collaboratively document what has been done. Often, students find that this document can be used
in a future portfolio to show skill competence and experience/exposure within a school setting. I
strongly recommend a daily or twice a week update of the PDE 430A so the data are organized for
the midterm and final evaluation documents. As the categories/areas on the two forms are
identical, feel free to state “see PDE 430A for additional information” when completing the
midterm and final evaluations.
In addition to the Student Professional Knowledge and Practice forms, PDE requires that student
interns show competency in a variety of skill different areas. This is done using the Pennsylvania
Department of Education Competencies for the Pre-field and Internship experiences. This multipaged chart is posted separately and needs to be completed (checkmarks) at the midterm and final
evaluation. Once done, print and sign the document and return it to Dr. Hegel.
Example of a completed PDE Form 430A
Student: Stew Dent
X Midterm Review
Final Review
Category I: Planning and Preparation
Lesson Unit Plans: Types Titles and Numbers
Dysphagia
Augmentative and Assistive Communication strategies
Receptive and Expressive language
Oral Motor Stimulation techniques
Fluency
Hearing Impairment
Articulation
Resources/Materials/Technology
Go Talk 4, Go Talk 9, Go Talk 20, Dynavox M3, Springboard Lite
Picture Exchange Communication System (PECS)
Assessment Materials
School Function Assessment
Preschool Language Scale 4 (PLS-4)
CAPP
Nonspeech Test
Oral motor stimulation technique checklists and remediation strategy information.
Information About Students
Student populations seen include those with: Autism Spectrum Disorder, Cognitive Delays, Multiple Handicaps.
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Student Teacher Interviews
Stew has successfully developed one joint learning activity with Special Education Teacher, Occupational
Therapists and Physical Therapists that will span 6 weeks of planning and preparation.
Classroom Observations
Weekly observations by Speech Supervisor, Special Education Teacher for 4 classrooms of students with
autism/multiple handicaps/cognitive delays.
Resource Documents
PECS Manual, Prentke-Romich and Dynavox download training info, Oral motor stimulation activity packets,
articles and inservice documents.
Other: Stew is reviewing the individual behavior plans for each student on the caseload.
Category II: Classroom Environment
Classroom Observations
Stew has developed nice skills for managing group activities for students with varying communication modes within
the classroom. Additionally, he checks with teachers regularly to see what academic concepts are being taught
during sessions and then provides appropriate target vocabulary support for students’ use of their
augmentative/assistive communication devices.
Informal Observations/Visits
Stew demonstrates a nice mix of kindness and structured expectations with the students. He enjoys them.
Student Teacher/Candidate Interviews
Stew listens well to constructive reviews of his sessions, makes notes, and follows up with suggestions.
Visual Technology
Stew has developed skills for use of Picture Exchange Communication System (PECS) and other assistive
communication visual technology.
Resources/Materials/Technology/Space
Stew looks at his daily schedule each morning and then prepares materials needed for students being seen that day.
He assists in the cleaning of our work area and sanitizes manipulative at the end of each day.
Other
Category III: Instructional Delivery
Classroom Observations
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Stew provides appropriate feedback to his students (short sentences that provide solid information on expectations).
He is verbally supportive, enthusiastic, kind and structured. The teachers have indicated he is an asset in providing
communication support in their classrooms.
Informal Observations
Stew genuinely enjoys these special needs students.
Assessment Materials
Stew has learned the School Function Assessment, the Developmental Assessment of Young Children and other
appropriate testing materials for this population
Student Teacher /Candidate Interviews
Stew asks appropriate questions of this Speech Supervisor regarding changes in student behaviors or need for
different strategies/ activities during sessions if he sees there are issues going on with our nonverbal students that he
may not be familiar with yet.
Student Assignment Sheets
Stew participates in all discussions with parents and teachers about students’ communication needs.
Student Work
Stew’s written report writing is exceptional. However, he is learning the brevity requirements for written school reevaluation reports, annual Individual Education Plans and quarterly progress reports.
Instructional Resources/Materials/Technology
Stew uses the augmentative and assistive technology online and written resource support. He also reads suggested
materials from other colleagues and professionals.
Other
Category IV: Professionalism
Teacher Conferences/Interviews
Stew is respectful of the colleagues and other professionals here. He asks questions about what is needed to support
students’ communication needs for academic learning.
Observations/Visual Technology
Stew provided power point support and assisted the leading of in-services to train teachers and para-educators on use
of an augmentative communication dynamic device.
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Artifacts/Interaction with Family
He has maturity and innate understanding of the complex issues our students’ parents and caregivers face. He
emphasizes the successes of a student as well as areas of need and always asks parents for their input.
Student Records /Grade book
Stew independently records data from each session into our computerized system and tracks attendance.
Progress Reports/Report Cards
Stew is currently working on quarterly progress reports. This involves tracking the data of speech sessions as well
as meeting with teachers to determine each student’s data progress on the objectives within the classroom
environment.
Parent/School/Community Feedback
Teachers, parents and school team members have stated positive comments on Stew’s skills and his enthusiasm.
Artifact Professional Development/Act 48 Documentation
Stew has attended the full inservice required.
Perceptive Use of Teaching/Learning Reflections
Exceptional skills displayed for understanding appropriate goals, objectives and accessibility requirements for our
students with severe disabilities.
Other:
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Example of a completed PDE 430 Evaluation
DOE
Student/Candidate’s Last Name
Number
JANE
Anna
Middle
First
xxx-xx-xxxx
Social Security
Speech-Language Pathology Services
K-8
Subject(s) Taught
Grade Level
This form is to serve as a permanent record of a student teacher/candidate’s professional performance evaluation
during a specific time period, based on specific criteria. This form must be used at least twice during the 12-week
(minimum) student teaching experience.
PERFORMANCE EVALUATION
Directions: Examine all sources of evidence provided by the student teacher/candidate and bear in mind the aspects of
teaching for each of the four categories used in this form. Check the appropriate aspects of student teaching, and
indicate the sources of evidence used to determine the evaluation of the results in each category. Assign an evaluation
for each of the four categories and then assign an overall evaluation of performance. Sign the form and gain the
signature of the student teacher.
Category I: Planning and Preparation – Student teacher/candidate demonstrates thorough knowledge of content and
pedagogical skills in planning and preparation. Student teacher makes plans and sets goals based on the content to be
taught/learned, knowledge of assigned students, and the instructional context.
Alignment: 354.33. (1)(i)(A), (B), (C), (G), (H)
Student Teacher/Candidate’s performance appropriately demonstrates:
Knowledge of content
Knowledge of pedagogy
Knowledge of Pennsylvania’s K-12 Academic Standards
Knowledge of students and how to use this knowledge to impart instruction
Use of resources, materials, or technology available through the school or district
Instructional goals that show a recognizable sequence with adaptations for individual student needs
Assessments of student learning aligned to the instructional goals and adapted as required for student needs
Use of educational psychological principles/theories in the construction of lesson plans and setting instructional goals
Sources of Evidence (Check all that apply and include dates, types/titles and number)
 Lesson/Unit Plans
 Student Teacher Interviews
 Resources/Materials/Technology
 Classroom Observations
 Assessment Materials
 Resource Documents
 Information About Students
 Other
(Including IEP’s)
Category
Exemplary 3 Points
(Distinguished)
Superior 2 Points
(Proficient)
Criteria for Rating
The candidate consistently
and thoroughly
demonstrates indicators of
performance.
The candidate usually and
extensively demonstrates
indicators of
performance.
Satisfactory 1 Point
(Basic but Experience and
Improvement Needed)
The candidate sometimes
and adequately
demonstrates indicators of
performance.
Unsatisfactory 0 Points
(Not trying/Poor Attitude/
Lack of Essential Skills)
The candidate rarely or
never and inappropriately
or superficially
demonstrates indicators of
performance.
Rating
2
(Indicate √)
Justification for Evaluation
Jane reviewed all student records for a working understanding of their speech-language impairment and their goals.
She developed therapy lessons through incorporating a variety of resource materials. Jane was able to adapt therapy
materials for a variety of therapy objectives. She expressed an interest in learning new assessment tools so she
studied the tests in preparation for initial evaluations and reevaluations. Jane demonstrated excellent growth in her
ability to plan and prepare for small group and classroom lessons.
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DOE
Student/Candidate’s Last Name
Number
JANE
Anna
Middle
First
xxx-xx-xxxx
Social Security
Category II: Classroom Environment – Student teacher/candidate establishes and maintains a purposeful and equitable
environment for learning, in which students feel safe, valued, and respected, by instituting routines and setting clear
expectations for student behavior.
Alignment: 354.33. (1)(i)(E), (B)
Student Teacher/Candidate’s performance appropriately demonstrates:
Expectations for student achievement with value placed on the quality of student work
Attention to equitable learning opportunities for students
Appropriate interactions between teacher and students and among students
Effective classroom routines and procedures resulting in little or no loss of instructional time
Clear standards of conduct and effective management of student behavior
Appropriate attention given to safety in the classroom to the extent that it is under the control of the student teacher
Ability to establish and maintain rapport with students
Sources of Evidence (Check all that apply and include dates, types/titles, and number)






Other
Classroom Observations
Informal Observations/Visits
Student Teacher/Candidate
Interviews
Category
Exemplary 3 Points
(Distinguished)
Superior 2 Points
(Proficient)
Criteria for Rating
The candidate
consistently and
thoroughly
demonstrates indicators
of performance.
3
The candidate usually and
extensively demonstrates
indicators of performance.
Rating
(Indicate √)
Visual Technology
Resources/Materials/Technology/Space
Satisfactory 1 Point
(Basic but Experience and
Improvement Needed)
The candidate sometimes and
adequately demonstrates
indicators of performance.
Unsatisfactory 0 Points
(Not trying/Poor Attitude/
Lack of Essential Skills)
The candidate rarely or never
and inappropriately or
superficially demonstrates
indicators of performance.
Justification for Evaluation
Jane demonstrated appropriate interactions with teachers and students. All students understood the routine of the
therapy session. Student behavior was well managed in both small groups and in classroom settings. Rapport was
easily and effectively established. Jane demonstrated an obvious enjoyment in working with the students and she
provided a positive learning environment through continuous positive reinforcement and through interactive
communication-related displays on the bulletin board.
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DOE
Student/Candidate’s Last Name
Number
JANE
Anna
Middle
First
xxx-xx-xxxx
Social Security
Category III – Instructional Delivery - Student teacher/candidate, through knowledge of content, pedagogy and skill in
delivering instruction, engages students in learning by using a variety of instructional strategies.
Alignment: 354.33. (1)(i)(D),(F),(G)
Student Teacher/candidate’s performance appropriately demonstrates:
Use of knowledge of content and pedagogical theory through his/her instructional delivery
Instructional goals reflecting Pennsylvania K-12 standards
Communication of procedures and clear explanations of content
Use of instructional goals that show a recognizable sequence, clear student expectations, and adaptations for individual
student needs
Use of questioning and discussion strategies that encourage many students to participate
Engagement of students in learning and adequate pacing of instruction
Feedback to students on their learning
Use of informal and formal assessments to meet learning goals and to monitor student learning
Flexibility and responsiveness in meeting the learning needs of students
Integration of disciplines within the educational curriculum
Sources of Evidence (Check all that apply and include dates, types/titles, or number)
 Classroom Observations
 Student Assignment Sheets
 Informal Observations/Visits
 Student Work
 Assessment Materials
 Instructional Resources/Materials/Technology
 Student Teacher/Candidate
Other
Interviews
Category
Exemplary 3 Points
(Distinguished)
Superior 2 Points
(Proficient)
Criteria for Rating
The candidate
consistently and
thoroughly demonstrates
indicators of
performance.
The candidate usually and
extensively demonstrates
indicators of performance.
Rating
(Indicate √)
Satisfactory 1 Point
(Basic but Experience and
Improvement Needed)
The candidate sometimes
and adequately
demonstrates indicators of
performance.
Unsatisfactory 0 Points
(Not trying/Poor Attitude/
Lack of Essential Skills)
The candidate rarely or never
and inappropriately or
superficially demonstrates
indicators of performance.
2
Justification for Evaluation
Jane has the ability to plan appropriate therapy activities at both the elementary and middle school levels, making use
of all materials available to her. When time allowed, she collaborated with classroom teachers to discuss the
communication and academic needs of the students to enhance therapy planning. Jane engaged all students in the
therapy/classroom sessions. She demonstrated increasing flexibility to alter the therapy plan as needed.
19
DOE
Student/Candidate’s Last Name
Number
JANE
Anna
Middle
First
xxx-xx-xxxx
Social Security
Category IV – Professionalism - Student teacher/candidate demonstrates qualities that characterize a professional
person in aspects that occur in and beyond the classroom/building.
Alignment: 354.33. (1)(i)(I),(J)
Student Teacher/Candidate’s performance appropriately demonstrates:
Knowledge of school and district procedures and regulations related to attendance, punctuality and the like
Knowledge of school or district requirements for maintaining accurate records and communicating with families
Knowledge of school and/or district events
Knowledge of district or college’s professional growth and development opportunities
Integrity and ethical behavior, professional conduct as stated in Pennsylvania Code of Professional Practice and
Conduct for Educators; and local, state, and federal, laws and regulations
Effective communication, both oral and written with students, colleagues, paraprofessionals, related service personnel,
and administrators
Ability to cultivate professional relationships with school colleagues
Knowledge of Commonwealth requirements for continuing professional development and licensure
Sources of Evidence (Check all that apply and include dates, types/titles, or number)
Classroom Observations
Student Assignment Sheets
Informal Observations/Visits
Student Work
Assessment Materials
Instructional Resources/Materials/Technology
Student Teacher Interviews
Other
Written Documentation
Category
Exemplary 3 Points
(Distinguished)
Superior 2 Points
(Proficient)
Criteria for Rating
The candidate
consistently and
thoroughly demonstrates
indicators of
performance.
3
The candidate usually and
extensively demonstrates
indicators of performance.
Rating
(Indicate √ )
Satisfactory 1 Point
(Basic but Experience and
Improvement Needed)
The candidate sometimes
and adequately
demonstrates indicators of
performance.
Unsatisfactory 0 Points
(Not trying/Poor Attitude
Lack of Essential Skills)
The candidate rarely or never
and inappropriately or
superficially demonstrates
indicators of performance.
Justification for Evaluation
Jane adhered to all school and district policies for appropriate dress, attendance, and punctuality. She maintained daily
log reports and consistently documented progress monitoring. She established a professional relationship with
teachers and administrators. Jane implemented a daily communication awareness activity for the entire elementary
school by having a speech-language student read a “good communication suggestion” during morning announcements.
20
DOE
Student/Candidate’s Last Name
Number
JANE
Anna
Middle
First
xxx-xx-xxxx
Social Security
Overall Rating
Category
Criteria for Rating
Exemplary
(Distinguished)
Superior
(Proficient)
Total: >11 to12 Points
Total: >7 to < l1 Points
The candidate
consistently and
thoroughly demonstrates
indicators of
performance.
The candidate usually and
extensively demonstrates
indicators of performance.
Rating
(Indicate √ )
Satisfactory
(Basic but Experience and
Improvement Needed)
Unsatisfactory
(Not trying/Poor Attitude
Lack of Essential Skills)
Total: > 4 to < 7 Points
The candidate sometimes
and adequately
demonstrates indicators of
performance.
Total: 0 to < 4 Points
The candidate rarely or never
and inappropriately or
superficially demonstrates
indicators of performance.
10
Note: This assessment instrument must be used a minimum of two times. PDE requires a satisfactory rating (1) in
each of the 4 categories, resulting in a minimum total of at least (4) points, must be achieved on the final summative
rating to favorably complete this assessment. However, EUP standards require a satisfactory score or better on both
the midterm and final evaluation. If your student intern will have a ZERO (0) in any area for either evaluation, please
contact Dr. Susan Hegel at shegel@edinboro.edu or at 814-732-2192.
Justification for Overall Rating:
Jane is rated in the Superior/Proficient range for her final review. It was a pleasure to work with her as a team to
provide the best services to our caseload of 62 students. She demonstrated an excellent work ethic in her ability to
efficiently and effectively prepare for daily/weekly lessons, maintain records, and collaborate with teachers on a
consistent basis. She also worked diligently to develop her therapeutic and diagnostic skills. Jane exhibited an
understanding of her role as a team member in the instructional support team process. She is prepared to fill a position
as a school-based speech-language pathologist.
DOE
JANE
Student Teacher/Candidate’s Last Name
Number
Anna
Middle
First
Minville District Main Street ELEMENTARY & MIDDLE
District/IU
School
Interview/Conference Date
School Year:
2010
Term:
xxx-xx-xxxx
Social Security
April 11, 2010
SPRING
Required Signatures:
Supervisor/Evaluator:
Date:
Student/Teacher
Candidate:
Date:
University Supervisor:
Date:
21
On-Site Visit Information
Faculty Liaison:
As the school-based Internship Coordinator, I will contact you periodically during the placement.
Usually contacts will be through phone calls and e-mails and our union mandates that at least one
on-site visit occur during the internship. However, on-line face-to-face meetings have recently
been approved as an alternative to an on-site visit if distance/travel is extensive. Therefore, I
would like to visit with some of you via Face Time, Skype or other on-line methods if the
technology is an option. Spending your/our tax dollars and my spring break on internship visits is
no longer fiscally responsible or necessary.
On-Site Visit:
The face-to-face visit of any type will be scheduled in the middle third of the placement (weeks 611), from late February through March for placements beginning in January and April and early
May for placements beginning in March. By this time the student has a daily routine, knows the
caseload, and is actively involved in service delivery. This means that you may be working with
your student for up to six to ten weeks before our on-site visit. If things are NOT going well,
please do not wait to voice your concerns. Call or e-mail me promptly if concerns start to surface.
I would much rather deal with small problems than big problems. My phone on campus is 814732-2192, my home phone is 814-734-2547, and my cell is 814-860-1178.
If we have arranged for an on-site visit, it will take at least an hour and could last up to two hours.
During the visit I will want to speak with the student in private and have a separate talk with you,
the school-based supervisor. Experience has shown that it is best to have the school-based
supervisor/EUP supervisor chat first. For your convenience, the list of questions we routinely ask
while visiting are listed below. Some supervisors have found it helpful to jot comments, make
notes, and keep data about the student’s performance on the question page so specific data can be
shared during the meeting. Completing the mid-term evaluation with your intern before the on-site
visit is also very helpful as the PDE 430 evaluation can be shared with the EUP faculty member.
If there are concerns about the student’s performance, attitude, work ethic, or any other issues, this
is your opportunity to voice them! These concerns will be brought up by the EUP supervisor in
the subsequent meeting with the student.
After both individual talks, the EUP supervisor will meet collectively with both of you to review
what is going well so far and to identify in collective company what, if anything, needs to be
improved or focused on for the rest of the internship. If a formal remediation plan is needed, it is
recommended that the two supervisors collaboratively draft a plan at this time. If not possible, an
additional meeting will need to be scheduled. The plan will be finalized by the EUP faculty within
a week and sent to the on-site supervisor for signatures.
22
Sample Questions for the On-Site School-based Supervisor
1. Describe the etiological diversity of your caseload and identify those clients/students who
are currently working with your EUP intern.
2. What percent of your caseload does the intern have at this point?
3. Has a mid-term evaluation been completed yet and if so, may I review the PDE 430 form?
4. Has your intern met and/or exceeded the ASHA clinical Clock hour requirements in
pediatric assessment (speech, language and hearing) and treatment (speech, and language)?
5. Tell me about your EUP intern’s
a. work ethic, initiative, and overall attitude;
b. time management skills;
c. interpersonal skills with students/clients and other professionals/staff in the
building;
d. response to supervision/feedback suggestions, and corrections;
e. clinical knowledge, skills, and judgment at this point;
f. treatment planning, treatment delivery, diagnostic skills and report writing abilities.
6. How much supervision do you feel your intern needs at this point in his/her development?
7. Was your student intern appropriately prepared for this placement? What suggestions do
you have that would improve student preparation for this internship placement?
23
PA Code of Professional Practice and Conduct for Educators
25
Please contact me if you have any questions. Thank you again for your willingness to be part of
our program and mentor our students. Though they may not recognize your gifts of time and
knowledge, we certainly do!
Susan L. Hegel, Ph.D., CCC-SLP
Coordinator of School-Based Internships
shegel@edinboro.edu
814-732-2192 work
814-860-1178 cell
814-732-2612 FAX