Teacher Candidate
Mentor Teacher
School
Grade/Subject
Date UCA Supervisor Time
LR1. List the outcomes (objectives), both academic and affective of the lesson. You will reference each of these as you respond to the next prompts (TESS 1c2).
LR2. Identify STRENGTHS in the lesson in relation to the academic and affective [social/emotional] objective(s). Use specific evidence from the lesson to support judgments (TESS 4a.1)
LR3. Identify WEAKNESSES in the lesson in relation to the academic and affective [social/emotional objective(s). Use specific evidence from the lesson to support judgments (TESS 4a.1).
LR4. To what extent were the objective(s) met by all learners? Use specific evidence from the lesson to support judgments (TESS 4a.1, 4b.1, 4b.2).
LR5. How will you use this experience to guide future instruction for this group of students? Explain why you have made this decision (TESS 4a.2).
LR6. Identify an individual or group of students who did well in today’s lesson. How do you account for this performance? What type of enrichment would you suggest to challenge this individual or
group of students? (TESS 4a.1, 4a.2, 4b.2)
LR7. Identify an individual or group of students who had difficulty in today’s lesson. How do you account for this performance? What type of support would you suggest to assist this student or group
of students with learning? (TESS 4a.1, 4a.2, 4b.2)
LR8. Add any other comments, reactions, or questions about this lesson. For example, is there
anything about which you felt particularly good, frustrated, or confused? (TESS 4e.2)
LR9. Complete the Professional Growth Plan Progress Chart below, being sure to align your plan of action and improvement goal with Part I of your Professional Growth Plan. This table will be used to help you write your reflection for the Professional Growth Plan (Part II) toward the end of the semester. You will need to share your progress as reflected in the chart with your supervisor at each lesson observation session.
Date Improvement Goal Plan of Action/Timeline Progress Made
Revised December 8, 2014

LR10. Update the 5 Professionalism Logs below to reflect your progress toward your Domain 4
Professionalism Collection. This collection will be a required attachment to your Domain 4 Reflective
Essay due toward the end of the semester. You will need to share your progress as reflected in the logs with your supervisor at each lesson observation session.
Teacher Candidate: School:
Mentor Teacher: Grade/Subject:
UCA Supervisor:
Maintaining Accurate Records Strategies Log
Document strategies you learn regarding maintenance of accurate records, both instructional and non-instructional.
(TESS 4b)
Date Physical Evidence Record Keeping Strategy –
Instructional Records
(Include source of your idea)
Record Keeping Strategy – Non
Instructional Records (Include source of your idea)
Family Contact Log
Document what forms of communication with parents/guardians you have used since the last meeting with your supervisor and provide physical evidence of this communication. (TESS 4c)
Date Person Contacted Type of Contact
(person, phone)
Purpose Outcome Physical Evidence
Professional Contribution and Relationship Building Among Colleagues Log
Document professional contributions you have made to assist your colleagues to grow professionally since the last meeting with your supervisor and provide physical evidence of these contributions. These contributions can include relationship building efforts with your colleagues related to sharing, planning and working together toward improved instructional skill and student success (TESS 4d.1), active contributions to professional organizations (TESS 4d.2), participation in school initiatives or special school projects (TESS 4d.3) and/or district-wide or community initiatives
(TESS 4d.4).
Date Contribution You Made Physical Evidence Event or Service
(conference presentation, mentoring, etc)
Revised December 8, 2014

Professional Development Log
Document ways you have worked to enhance your content knowledge and pedagogical skills. Offer evidence of workshop(s) attended, professional literature you’ve read, professional conference session(s) you’ve attended, or action research you’ve conducted that focuses on improving your teaching (TESS 4e.1 and 4e.3)
Date Event (committee meeting,
Open House, etc.)
Benefits Derived Physical Evidence
Date Feedback Given By
Response to Feedback Log
Document ways you have sought and used feedback from your supervisor and mentor teacher to grow professionally.
(TESS 4.e.2).
Description of Feedback Response to
Feedback/Changes Made
Revised December 8, 2014