Approved CAP Instructor
Observation Form
All documentation is due in the CAP Office by the last Friday in May.
*Be sure to sign in at the high school office before proceeding to the classroom.
CAP Teacher _______________________________ USI Course Title ___________________________
High School ____________________________________________ Date of Visit ______/______/______
Liaison Name ____________________________________ Date Report Submitted _____/_____/______
*If convenient, you may use a personal vehicle and be reimbursed for mileage if odometer readings are entered,
below. To arrange use of a departmental vehicle, please contact the CAP Office at 812/228-5022.
Mileage at Departure _______________________ Departure Location (USI or Home) _______________
Mileage at Return __________________________ Return Location (USI or Home) _________________
Faculty Liaison Signature_____________________________________ Date ______________________
(if submitting digitally, include digital signature, CAP staff can create if needed )
Before submitting this report to the CAP office, attach copies of syllabi for the current
CAP course and an on-campus section of the same course, as well as sample PAIRED
assessment tools for both sections. Please use the following checklist as a reminder
to review and include required items for each visit.
Reviewed with Instructor:
☐ Syllabus
☐ Written assignments and assessments
☐ Graded student work
☐ Approved College Level Textbook
☐ Copies of the following documentation attached:
☐ paired syllabi with CAP syllabus including CAP enrollment info
☐ paired assessments
For CAP Office Use Only
Report received and reviewed by CAP staff.
Liaison stipend processed.
Initials
Date
Initials
Date
You may reformat this report for your convenience; however, please be certain to include
all information requested.
1. Does the instructor demonstrate through his/her presentation a college-level grasp of the
subject matter?
2. Was there reasonable participation from the class? If you have an opportunity to talk with
students, include comments in your discussion.
OVER
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3. Comment on the degree of difficulty of exams and quizzes. Are the evaluation tools
comparable to those used on campus?
4. Ask to see some activities or assignments the students have generated thus far in the course.
Do the activities/assignments indicate that college-level material has been covered? Are they
representative of what you see from students enrolled in the same course on campus?
If possible, attach examples of assessment tools and/or assignments used in the classroom.
5. Comment on the teacher’s grading and evaluation of students.
6. Do you have any comments on how to make this program more effective for the students?
7. Do you have any comments on the high school itself or its staff? (e.g. appearance,
cooperation)
8. Were there any comments regarding CAP from high school personnel – administrators or the
teacher – that should be noted?
Payments for observation visits are made upon submission of the report and
supporting paperwork. Be certain all visits are conducted and all documentation
submitted to the CAP office no later than the last Friday in May, so that payments
can be made from the current operating budget (no later than June 30).
Revised 5/30/2013 jd