Instruction: Design, Delivery, Assessment
Worksheet
Sponsoring Organization
Program/Group of Programs
Initial Teacher – Baccalaureate
Instruction Worksheet for:
Initial Teacher – Post-Baccalaureate
Initial Specialist Teacher (e.g. Reading Specialist)
Professional Support Personnel
Required Documents in this Domain:

Program of Study

All associated course descriptions
Administrative Leadership
As applicable (see your Submission Requirements Chart for program specific requirements):

Subject Matter Knowledge (SMK) Matrix

Professional Standards for Teachers (PST) matrix

Professional Standards for Library Teachers (PST) matrix

Professional Standards for Administrative Leadership (PSI) matrix

Associated course syllabi
ESE names and approves programs according to the licensure role (e.g., Elementary 1-6, Initial, Post-
Baccalaureate) for which candidates are endorsed. Sponsoring Organizations may have one or more
“program variations” that result in that endorsement (e.g., MAT in Elementary Ed, MEd in Elementary
Ed, licensure-only, etc.). To ensure that ESE has a record and has approved all of the pathways to endorsements, we ask that you include a full list of the program variations below. Each variation should
have its own program of study.
If your organization has only a single route to obtaining the licensure endorsement, you do not have to complete this portion of the worksheet. If you are unclear, ask your Ed Prep Specialist for more details.
Educator Preparation Review 1
Resources: http://www.doe.mass.edu/edprep/resources.html
Review Toolkit: http://www.doe.mass.edu/edprep/toolkit/

Instruction: Design, Delivery, Assessment
Worksheet
Program Variation: List each program variation below.
Variation Title
Variation Title
Variation Title
Variation Title
Program Delivery: Indicate the ways in which the program(s) are delivered. Check all that apply.
On Campus Program
Online/Hybrid Program
Satellite Program
Statements of Assurances: There are several regulatory expectations for preparing candidates for licensure in Massachusetts. By checking the boxes below, you are affirming that the program was developed in a way that fully addresses these requirements. It is the expectation that programs be built on strong inputs and produce positive outcomes for candidates.
Practicum hours meet regulatory requirements as per 603 CMR 7.04 (4)
Program of Study meets regulatory requirements for applicable licenses set forth in 603 CMR 7.03 (3) (a) and (b) and 7.04 (2) (c) 5. b. i. or c. i.
Program of Study addresses all SMK requirements set forth in 603 CMR 7.06
,
7.07
, 7.09
, and 7.11
at the appropriate licensure level (if applicable).
Program of Study addresses all Professional Standards set forth in 603 CMR 7.08
or 7.10
at the appropriate licensure level (if applicable).
Educator Preparation Review 2
Resources: http://www.doe.mass.edu/edprep/resources.html
Review Toolkit: http://www.doe.mass.edu/edprep/toolkit/

Instruction: Design, Delivery, Assessment
Worksheet
Outcome Criteria:
Prompt 1: Describe the evidence your organization will use to demonstrate that completers have the content knowledge (SMK) necessary to be effective in their specific licensure role.
Prompt 2: Describe the evidence your organization will use to demonstrate that completers have the pedagogical skills necessary to be effective in the licensure role.
200 words
200 words
Prompt 3: Describe the evidence your organization will use to demonstrate that completers have a positive impact on outcomes for PK-12 students.
250 words
Supporting Criteria:
Prompt 4: Explain how the program(s) of study are sequenced to support the increased depth of skills and knowledge over time.
200 words
Prompt 5: Explain how the program of study is coherent such that connections among courses are evident.
200 words
Educator Preparation Review 3
Resources: http://www.doe.mass.edu/edprep/resources.html
Review Toolkit: http://www.doe.mass.edu/edprep/toolkit/

Instruction: Design, Delivery, Assessment
Worksheet
Prompt 6: Explain how content is differentiated by subject area and grade levels
(i.e., 5-8, 9-12).
200 words
Prompt 7: Describe how your organization ensures that content delivery is consistent within the program (e.g. across different instructors, in satellites, via online, etc.).
200 words
Prompt 8: Describe the evidence your organization will use to demonstrate that faculty/instructors model effective pedagogical and content practices of the discipline (including strategies to meet the diverse needs of learners).
200 words
Prompt 9: Explain how faculty/instructors use formative and summative data to target areas of candidate need.
200 words
Educator Preparation Review 4
Resources: http://www.doe.mass.edu/edprep/resources.html
Review Toolkit: http://www.doe.mass.edu/edprep/toolkit/

Instruction: Design, Delivery, Assessment
Worksheet
Prompt 10: Describe the evidence your organization will use to demonstrate that candidates receive targeted feedback from faculty/instructors that improves their practice.
300 words
Optional: Provide additional context pertaining to the design, delivery or assessment of instruction within this program/group of programs.
Supplemental Documents
Optional: Provide additional documents pertaining to partnerships.
Title of Document Rationale for Including
250 words
50 words each
Educator Preparation Review 5
Resources: http://www.doe.mass.edu/edprep/resources.html
Review Toolkit: http://www.doe.mass.edu/edprep/toolkit/