Acknowledgements
This handbook was created with input and support from:
Arizona Revised Statute § 15-203(A)(38)
District Administrators and Specialists
Charlotte Danielson, Enhancing Professional Practice: A Framework for Teaching (2nd Edition)
Electronic Forms and Rubrics for Enhancing Professional Practice: A Framework for Teaching,
by Charlotte Danielson. Alexandria, VA: ASCD, 2008. Used by permission. All rights
reserved.
Mesa Public Schools Educators
The Arizona State Board of Education, Arizona Framework for Measuring Educator Effectiveness
2
Table of Contents
District Vision, Mission, Core Values, Priorities and Goals
5
Evaluation Introduction
6
Specialist Performance
6-8
Professional Development
Professional Refinement Plan
8
Professional Remediation Plan
8
Inadequate Specialist Performance
8-9
Appeal of Evaluation
Evaluation Timelines and Activities
9
10
Forms
Specialist Performance Evaluation
Nurse Performance Evaluation (Form 1A)
12-20
Psychologist Performance Evaluation (Form 1B)
21-32
Instructional Specialist Performance Evaluation (Form 1C)
33-42
Therapeutic Specialist Performance Evaluation (Form 1D)
43-51
Student Advisor Performance Evaluation (Form 1E)
52-61
K-8 Counselor Performance Evaluation (Form 1F)
62-70
Performance Evaluation Profile and Rating
Nurse Performance Profile and Rating (Form 2A)
71-72
Psychologist Performance Profile and Rating (Form 2B)
73-75
Instructional Specialist Performance Profile and Rating (Form 2C)
76-77
Therapeutic Specialist Performance Profile and Rating (Form 2D)
78-79
Student Advisor Performance Profile and Rating (Form 2E)
80-82
K-8 Counselor Performance Profile and Rating (Form 2F)
3
83-84
Professional Refinement Plan (Form 3)
85
Professional Remediation Plan (Form 4)
86
Notice of Inadequate Specialist Performance-Fall (Form 5)
87
Notice of Inadequate Specialist Performance-Final (Form 5)
88
Appendix
Appendix A-List of Specialists
90
Appendix B-Summary of Domains
91
Appendix C-Performance Classifications
92
4
District Vision, Mission, Core Values, Priorities and Goals
Vision Statement
Unprecedented Excellence in Education
Mission Statement
The mission of Mesa Public Schools is to develop a highly educated and productive community, one student
at a time.
Core Values
In Mesa Public Schools, we believe…
…each child is important.
…learning is our focus.
…collaboration and innovation are indispensable.
…sound fiscal stewardship is essential.
…diversity increases our opportunities.
…success is expected and celebrated.
Priorities and Goals
Priority 1: Learning and Achievement
Goals
1.
2.
3.
4.
Provide educational offerings that maximize learning and achievement by meeting individual student’s varied
needs and interests.
Maximize the efficient and effective use of time, resources and staff to ensure academic excellence.
Monitor and support the academic progress of students.
Expect all stakeholders to take personal responsibility for student learning.
Priority 2: Relevant and High-Quality Comprehensive Curriculum
Goals
1.
2.
3.
4.
Develop and implement a comprehensive, relevant curriculum that is aligned with state academic standards.
Provide a wide range of co-curricular and extracurricular opportunities to develop a wide variety of skills.
Provide an optimal learning environment for high student performance.
Utilize technology that is relevant and enhances learning.
Priority 3: Highly Qualified and Highly Effective Personnel
Goals
1.
2.
3.
Recruit highly qualified personnel.
Retain highly effective personnel.
Provide professional and personal support, recognition and rewards.
Priority 4: Safe Health and Nurturing Learning Environments
Goals
1.
2.
3.
4.
Incorporate health, physical activity and nutrition concepts into the curriculum.
Provide a safe environment.
Maintain a clean environment.
Provide a supportive environment for the workplace and educational excellence.
Priority 5: Students, Staff, Parents and Community Working Together
Goals
1.
2.
3.
Provide timely and accurate information.
Promote and expand involvement with all families.
Develop meaningful, student-oriented community partnerships.
Priority 6: Optimal and Equitable Utilization of Resources
Goals
1.
2.
3.
Capitalize on all viable revenue sources.
Allocate district resources in an equitable manner.
Manage district resources efficiently and effectively while emphasizing quality.
5
Evaluation Introduction
The Mesa Public Schools specialist evaluation system is a collaborative model leading to improved
specialist performance, enhanced teaching and increased student achievement. All employees listed
in Appendix A will be evaluated using the specialist evaluation system. Mesa Public Schools has
developed a specialist evaluation system that aligns with the classroom teacher evaluation system
and the vision, mission, core values, priorities and goals that are part of the district’s strategic plan.
The evaluation system includes annual evaluations for specialists, using rubrics aligned with job
performance expectations.
The specialist evaluation system is intended to bring clarity, conversation and improvements to
specialist performance by:




Providing a common district wide definition of effective specialist performance
Embracing meaningful discussion and collaboration regarding professional practice
Focusing on continuous growth for all specialists
Identifying and emphasizing strategies that provide the greatest support for teaching and
student learning
Based on established rubrics, the performance indicators of Highly Effective, Effective,
Developing and Ineffective will be used to rate specialist performance.
Specialist Performance
Charlotte Danielson’s Frameworks for Specialists were used as a resource and guide in establishing
specialist frameworks for Mesa Public Schools. The specialist performance evaluations are
organized into four domains and 22 components. The four domains are listed below. Descriptions
of the domains can be found in Appendix B.




Planning and Preparation
The Environment
Delivery of Service
Professional Responsibilities
Mesa Public Schools will refer to the specialist frameworks as the Specialist Performance
Evaluations (Nurses- Form 1A, Psychologists-Form 1B, Instructional Specialists-Form 1C and
Therapeutic Specialists-Form 1D, Student Advisors-Form 1E, K-8 Counselors-Form-1F). The
Specialist Performance Evaluations identify specialist job expectations and responsibilities.
Evidence of specialist performance will be gathered for all components of the framework. Evidence
for all domains will be collected through pre- and post-observation conferences, observation
experiences, program planning documents, communication logs, conversations about specialist
practice, and other professional artifacts.
The Specialist Performance Evaluations emphasize that planning precedes the work as a specialist;
a positive and engaging environment must be in place for delivery of quality services; and
specialists embracing high professional standards contribute to better performance.
Evaluators will be required to conduct one observation experience before completing the Fall
Summative Specialist Performance Evaluation and one observation experience before
completing the Spring Summative Specialist Performance Evaluation. The evaluator will give
6
the specialist prior notice of the observation experience for the Fall Summative Specialist
Performance Evaluation.
The evaluator, in consultation with the specialist, will establish an observation experience that
will serve in place of the formal classroom observation required for classroom teacher
evaluations. The observation experience may consist of one or more physical observations of the
specialist while delivering services in the work environment. The duration of the observation
experience as a whole will be sufficient to allow the specialist to demonstrate delivery of skills
assessed through the evaluation instrument.
During pre- and post-observation conferences, which are part of the specialist evaluation process,
specialists must be prepared to engage in professional dialogue with the evaluator regarding job
expectations and performance. Within 10 business days after each observation experience, a
post-observation conference must be completed and the evaluator must provide written feedback
to the specialist. The specialist will also be provided the opportunity to complete a self-review
during the Fall and Spring Summative Specialist Performance Evaluations. Specialists will be
evaluated in each of the 22 components based on the evidence collected through pre- and postobservation conferences, observation experiences, self-reviews, program planning documents,
communication logs, conversations about specialist practice, and other professional artifacts.
Written communications and other information regarding interactions with students, parents, and
co-workers may be considered by the evaluator, provided that the specialist is given an
opportunity to comment on the information during a conference or other communication with the
evaluator.
If a specialist has continuing teacher status as defined in A.R.S. §15-538.01(D), or is a nurse or
psychologist or audiologist who has been employed by the district for the major portion of three
consecutive school years and receives a “Highly Effective” or “Effective” rating on the Fall
Summative Specialist Performance Evaluation, the evaluator may waive the requirement of
conducting a Spring Summative Specialist Performance Evaluation. If the waiver occurs, the
employee’s Final Summative Specialist Performance Evaluation will be completed using the Fall
Summative Specialist Performance Evaluation scores. The evaluator or specialist may request
the completion of a Spring Summative Specialist Performance Evaluation.
All other specialists will receive a Fall Summative Specialist Performance Evaluation and Spring
Summative Specialist Performance Evaluation. The results of the two evaluations will be used
to complete a Final Summative Specialist Performance Evaluation. If the specialist receives
unequal scores for the same component of the Fall and Spring Summative Specialist
Performance Evaluations, the evaluator will determine, in his or her sole discretion, which score
most accurately reflects the specialist’s performance over the school year. At least 60 calendar
days must elapse between the observation experience of the Fall Summative Specialist
Performance Evaluation and the observation experience of the Spring Summative Specialist
Performance Evaluation.
A specialist scheduled to be evaluated by a school principal or other evaluator rated “Ineffective” or
“Unsatisfactory” for the preceding school year may decline to be evaluated by the evaluator. By
September 1, the district will notify specialists who have the foregoing right. The specialist must
exercise the right by delivery of written notice to the Assistant Superintendent of Human Resources
no later than September 15 of the current school year. Upon receipt of notice from the specialist,
the Assistant Superintendent of Human Resources will assign responsibility for the specialist’s
evaluation to another evaluator.
7
After the review of all specialist performance evidence, the specialist will receive a Final
Summative Specialist Performance Evaluation that will be used to determine the Specialist
Performance Profile and Rating (Form 2) resulting in a Final Specialist Evaluation Rating of
Highly Effective, Effective, Developing or Ineffective as adopted by the governing board. The
classifications and descriptions can be found in Appendix C.
Professional Development
Professional Refinement Plan
A Professional Refinement Plan (Form 3) will be established for every specialist who receives a
final rating of “Highly Effective” or “Effective” on the Specialist Performance Profile and Rating
(Form 2). Prior to the end of the present school year, the evaluator, in collaboration with the
specialist, will develop a plan to target an area for refinement. The professional refinement plan
will be implemented throughout the next evaluation cycle.
Professional Remediation Plan
A Professional Remediation Plan (Form 4) will be established for every specialist who receives a
final rating of “Developing” or “Ineffective” on the Specialist Performance Profile and Rating
(Form 2) or at any time at the discretion of the evaluator. The evaluator, in collaboration with the
specialist, will develop a plan to target the areas(s) of deficiency. The plan will include goals,
strategies, and action steps; identify training opportunities and other resources available for the
employee to correct the deficiencies and demonstrate adequate specialist performance; and specify
the date by which the employee must correct any deficiencies and demonstrate adequate specialist
performance.
Inadequate Specialist Performance
A specialist shall be deemed inadequate when he or she receives a rating of “Ineffective” as a result
of the Fall or Final Summative Specialist Performance Evaluation, or a rating of “Developing” or
“Ineffective” as a result of the Fall or Final Summative Specialist Performance Evaluations for two
consecutive school years.
If a specialist meets the definition of Inadequate Specialist Performance based on the Fall or Final
Summative Specialist Performance Evaluations, the evaluator will initiate the inadequate specialist
performance process by completing the Notification of Inadequate Specialist Performance (Form 5)
and submitting the form and the signed Specialist Performance Profile and Rating (Form 2) to the
Human Resources Department. The fall notification must occur prior to the last Monday in
November and the spring notification prior to the last Monday in April.
The Superintendent may issue a preliminary notice of inadequate specialist performance at any time
if the specialist meets the definition of inadequate specialist performance outlined above. If the
inadequate specialist performance process is not completed by the end of the school year in which it
started, the process will continue in the following school year as necessary to allow the specialist
the opportunity to complete the Professional Remediation Plan (Form 4), correct inadequacies and
demonstrate adequate specialist performance.
If a specialist has been issued a preliminary notice of inadequate specialist performance, the
Assistant Superintendent of Human Resources will assign a second evaluator to independently
complete a second summative evaluation, which will include a review of all evidence collected by
the original evaluator and at least one observation experience completed by each evaluator after the
employee has been given an opportunity to complete a Professional Remediation Plan. The original
8
evaluator and second evaluator will meet to determine whether there is interrater agreement
identifying the employee has corrected inadequacies and demonstrated adequate specialist
performance. The evaluators will inform the employee and the Assistant Superintendent of Human
Resources of the results of the Fall or Final Summative Specialist Performance Evaluation.
If a specialist receives a preliminary notice of inadequate specialist performance, the notice will be
accompanied by a Professional Remediation Plan that is designed to help the specialist correct
inadequacies and demonstrate adequate specialist performance. The plan will include goals,
strategies, and action steps; identify training opportunities and other resources available for the
employee to correct the deficiencies and demonstrate adequate specialist performance; and specify
the date by which the employee must correct any deficiencies and demonstrate adequate specialist
performance. The Professional Remediation Plan will remain in effect for not less than 45
instructional days.
Appeal of Evaluation
A specialist who disagrees with a Final Summative Specialist Performance Evaluation may submit a
written appeal to the Assistant Superintendent of Human Resources or designee within 10 calendar
days after receipt of the evaluation instrument. The appeal must describe with specificity the alleged
error or errors that are the basis for the appeal. Allegations of error regarding the evaluator’s
judgment of the specialist’s performance during an observation experience will not be considered in
an appeal, if the evaluator’s perceptions of the specialist’s performance with regard to specific
elements are properly documented. The Assistant Superintendent may decline to consider an appeal
if the appeal is not timely or if the Assistant Superintendent determines that the evaluation will not
affect the employee’s eligibility for, or amount of, performance pay, or other form of compensation
and will not materially affect an administrative decision regarding the employee’s employment for
the subsequent school year.
9
Evaluation Timelines and Activities
Timeline
Activities
Within the first two weeks
of the school year
Specialist Evaluation Orientation
 Evaluator will provide an overview of the specialist evaluation system to all
specialists.
Fall Summative Specialist Performance Evaluation
 Collect evidence for Domains 1, 2, 3 and 4 through the pre- and post-observation
conference process and the observation experience
 Specialist completes self-review
 Complete the Fall Summative Specialist Performance Evaluation and record
component scores in the Specialist Performance Profile and Rating (Form 2)
Spring and Final Summative Specialist Performance Evaluations
 Collect evidence for Domains 1, 2, 3 and 4 through the pre- and post-observation
conference process and the observation experience
 Specialist completes self-review
 Complete the Spring and Final Summative Specialist Performance Evaluations for all
probationary specialists and continuing status specialists requiring a Spring
Summative Specialist Performance Evaluation and record component scores in the
Specialist Performance Profile and Rating (Form 2)
 Complete and submit each specialist’s signed Specialist Performance Profile and
Rating (Form 2) to the Human Resources Department
 Final Summative Specialist Performance Evaluation scores will be used for specialist
RIF profiles
Development of Refinement Plans
 A Professional Refinement Plan (Form 3) will be established for every specialist
who receives a final rating of “Highly Effective” or “Effective” on the Specialist
Performance Profile and Rating (Form 2). Prior to the end of the present school year,
the evaluator, in collaboration with the specialist, will develop a plan to target an area
for refinement. The professional refinement plan will be implemented throughout the
next evaluation cycle.
Development of Remediation Plans
 A Professional Remediation Plan (Form 4) will be established for every specialist
who receives a final rating of “Developing” or “Ineffective” on the Specialist
Performance Profile and Rating (Form 2) or at any time at the discretion of the
evaluator. The evaluator, in collaboration with the specialist, will develop a plan to
target the areas(s) of deficiency.
Prior to the end of the first
semester
Prior to the end of March
Prior to the last day of
school
No timeline
10
Forms
11
Nurse Performance Evaluation (Form 1A)
Employee:
School Year:
EIN:
School:
Fall Summative Evaluation
Evaluator:
Status:
Probationary
Date:
□
□
Spring Summative Evaluation
Continuing
□
Evaluation
□
□
Self-Review
□
DOMAIN 1 FOR NURSES: PLANNING AND PREPARATION
COMPONENT
1a.
Demonstrating knowledge of
school nurse practice by
maintaining student health and
safety on campus/Understanding
the professional, ethical and legal
standards that guide the nurse in
the school setting
INEFFECTIVE
Nurse demonstrates little
understanding of school nurse
practice. Nurse has little
understanding of professional
expectations and legal regulations
related to the practice of school
nursing.
DEVELOPING
Nurse demonstrates basic
understanding of school nurse
practice, through the utilization of
data, documentation and treatment
planning. Nurse has basic
understanding of professional
expectations and legal regulations
related to the practice of school
nursing.
EFFECTIVE
HIGHLY EFFECTIVE
Nurse demonstrates adequate
understanding of School nurse
practice, through the utilization of
data, documentation and
treatment planning. Nurse has
understanding of professional
expectations and legal regulations
related to the practice of school
nursing.
Nurse demonstrates deep and
thorough understanding of school
nurse practice. School nurse actively
maintains student health through
assessment, planning, treatment,
documentation and evaluation. The
school nurse has a thorough
understanding of the ethical
expectations and legal regulations
and provides leadership in sharing
such knowledge with colleagues.
□
□
□
□
Nurse displays little knowledge of
child and adolescent development
and has little ability to assess student
developmental milestones.
Nurse displays basic knowledge of
child and adolescent development.
Supports are needed to further skills
in developmental assessment.
Nurse displays accurate
understanding of child and
adolescent development and is
able to apply this knowledge in
health teachings, health promotion
and special education meetings.
□
□
Nurse displays thorough knowledge
of child and adolescent development.
Nurse displays knowledge of
development delays and their impact
on student performance. Nurse
provides leadership in sharing such
knowledge with colleagues.
□
□
EVIDENCE:
1b:
Demonstrating knowledge of child
and adolescent development
EVIDENCE:
12
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1c:
Establishing goals for the school
health program appropriate to the
setting and the students served
Nurse has no clear goals for the
school health program, or they are
inappropriate to either the situation or
the age of the students.
□
Nurse’s goals for the school health
program are rudimentary and are
partially suitable to the situation and
the age of the students.
□
Nurse’s goals for the school
health program are clear and
appropriate to the situation and
age of the students. Nurse is able
to coordinate work and establish
goals independently by
communicating with the school
community.
□
Nurse's goals for the school health
program are highly appropriate to the
situation and to the age of the
students. Goals have been
developed through consultations with
students, parents, and/or colleagues.
□
EVIDENCE:
1d:
Demonstrating knowledge of
nursing scope of practice/Utilizing
district resources and health
manual procedures/Following
state and federal regulations, by
maintaining appropriate license
and certifications
Nurse demonstrates little or no
knowledge of nursing scope of
practice, governmental regulations or
district procedures/resources.
Nurse demonstrates basic
knowledge of nursing scope of
practice. Nurse displays awareness
of governmental regulations and of
most district procedures/resources.
Nurse demonstrates limited
knowledge of resources available
within the community.
Nurse demonstrates adequate
knowledge of nursing scope of
practice. Nurse displays
awareness of governmental
regulations, district procedures
and resources for students
available through the school,
district and the community.
Nurse demonstrates substantial
knowledge of nursing scope of
practice. Nurse’s knowledge of
governmental regulations, district
procedures and resources is
extensive. Nurse takes a leadership
role in sharing knowledge and
participates in department review and
ongoing evaluation of health manual
guidelines.
□
□
□
□
Nurse does not appear to have an
overall plan but instead provides
services in a seemingly random way.
Nurse does not use a problemsolving framework to work with
teachers, colleagues, and parents in
writing and implementing care plans
for the students.
Nurse writes an individual healthcare
plan but does not individualize the
plan. Does not consistently use a
problem-solving framework.
Nurse writes student individual
healthcare plans that are
individualized and utilizes problem
solving approach to respond to
concerns by consulting with
parent and medical provider.
Nurse is able to collaborate with
school staff in implementing the
plan.
Nurse writes, individualizes and
implements student individual
healthcare plans that are detailed,
relevant and appropriate to the
school setting. Nurse consistently
utilizes problem solving framework in
responding to concerns and assumes
a leadership role in training.
□
□
□
□
EVIDENCE:
1e:
Writing individual healthcare plans
for students
EVIDENCE:
13
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1f:
Demonstrating knowledge of
school and community resources
Nurse has little knowledge of school
and community resources. Does not
know how to access district
resources webpage.
Nurse has some knowledge of school
and community resources and may
occasionally research resources.
□
□
Nurse utilizes resources for the
benefit of students or the school
community.
□
Nurse utilizes and develops
resources for the school and
community. Nurse regularly provides
feedback regarding the use of
resources.
□
EVIDENCE:
14
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 2 FOR NURSES: THE ENVIRONMENT
COMPONENTS
2a:
Creating an environment of
respect and rapport in
professional relationships and
with students, staff and parents
INEFFECTIVE
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
Nurse’s interactions with some staff,
students or parents may be negative
or inappropriate. School nurse rarely
engages in collaborative, effective,
and/or ethical professional
relationships. The school nurse does
not promote teamwork.
Nurse’s interactions with staff,
students or parents are a mix of
positive and negative. School nurse
engages in some collaborative
relationships but these are not
always effective.
Nurse’s interactions with students,
parents or staff are positive and
respectful. The school nurse
engages in collaborative, effective,
and ethical professional
relationships that promote a
positive team environment.
In addition to the standard, students,
staff and parents often seek out the
nurse, reflecting a high degree of
comfort and trust in the relationship
and collaborative outcomes.
□
□
□
□
Nurse makes no attempt to establish
a culturally sensitive environment in
the health office.
Nurse attempts to establish a
culturally sensitive environment in the
health office, but additional support
and training are necessary.
Nurse promotes a culturally
sensitive environment in the
health office by understanding the
cultural diversity of the school
population.
A culturally sensitive environment is
promoted and fostered by the school
nurse. The school nurse actively
seeks knowledge and works with
others to promote acceptance.
□
□
EVIDENCE:
2b:
Establishing an environment that
is culturally sensitive
□
□
EVIDENCE:
2c:
Utilizing health protocols and
procedures in providing care to
students
Nurse does not consistently follow
procedures as outlined in the health
manual and state/county
immunization reporting guidelines.
Nurse partially follows procedures.
Nurse is able to locate district policy,
health services guidelines and is
aware of immunization regulations.
Nurse follows procedures in a
consistent and predictable
manner, utilizing the health
services manual and other
state/county reporting documents.
Identifies and refer students who
are not in compliance with State
Immunization Law.
In addition to the standards, nurse
consistently follows procedures in a
seamless fashion, anticipating
unexpected situations. Suggestions
for changes are appropriate and data
driven.
□
□
□
□
EVIDENCE:
15
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
2d:
Supervising health assistants
No guidelines for delegated duties
have been established or the
guidelines are unclear. Nurse does
not monitor health assistant activities
or documentation.
Nurse’s efforts to establish guidelines
for delegated duties are partially
successful. Nurse monitors health
assistant activities sporadically.
Nurse has established guidelines
for delegated duties and monitors
health assistant activities on a
regular basis including review of
documentation and ongoing
mentoring.
Nurse provides clear guidance and
ongoing supervision of the health
assistant. Nurse facilitates
independent and safe functioning of
health office duties by the health
assistants and provides ongoing
mentoring.
□
□
□
□
Health office is well organized and
clean. Resource information and
student care plans are accessible
and substitute folder is up to date.
Health office is efficiently organized.
Resource information, care plans and
student information is accessible.
Nurse is able to prioritize
organizational tasks.
□
□
EVIDENCE:
2e:
Organizing health office
Health office is disorganized and
unkept. Substitute folder is not
properly maintained.
□
Health office is adequately
organized, and clean. Substitute
folder is often out of date.
□
EVIDENCE:
16
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 3 FOR NURSES: DELIVERY OF SERVICE
COMPONENTS
3a:
Assessing student needs
INEFFECTIVE
DEVELOPING
EFFECTIVE
HIGH EFFECTIVE
Nurse does not assess student
needs or the assessment results are
inaccurate. Cannot apply triage
principles to identify critical incident.
Nurse provides basic assessment of
student's needs and can apply some
triage principles.
Nurse provides adequate
assessment of student needs and
applies appropriate interventions
during incidents of a critical
nature.
Nurse conducts detailed and
individualized assessment of student
needs and applies intervention
strategies to determine the best use
of resources.
□
□
□
□
Medications are appropriately
administered by designated
individuals. Nurse evaluates and
re-adjusts delegation duties as
needed. Medications are properly
stored and well organized.
Medications are administered by
designated individuals in a highly
effective manner. Students take an
active role in medication compliance.
Parent and medical provider are
informed of potential problems in a
timely and professional manner.
EVIDENCE:
3b:
Administering medications to
students
Medications are administered with no
regard to state or district policies.
Medications are not properly stored.
Medications are administered by
designated individuals. Nurse
assures basic training of delegated
persons and effective record
keeping. Medications are difficult to
find.
□
□
□
□
Nurse does not provide wellness
education programs or provide public
health information to school
community.
Nurse promotes wellness through
classroom presentations or individual
education. Public health information
is not clear and concise.
Nurse promotes wellness through
classroom presentations and
individual education. Public health
information and monitoring are
performed on a regular basis and
are effective.
Nurse promotes wellness through
classroom presentations and
individual education. Public health
information and monitoring are highly
effective. Positive life choices are
encouraged.
□
□
□
□
EVIDENCE:
3c:
Promoting wellness through
individual, classroom or school
wide education and acts as a
public health resource
EVIDENCE:
17
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
3d:
Managing emergency situations
Nurse has no contingency plans for
emergency situations.
Nurse’s plans for emergency
situations have been developed for
the most frequently occurring
situations.
Nurse’s plans for emergency
situations have been developed
for many situations and are clear
and concise.
Nurse's plans for emergency
situations have been developed for
many situations. Students and
teachers have learned their
responsibilities in case of
emergencies. Nurse provides input
into preparedness planning and
follow-up.
□
□
□
□
Nurse declines to collaborate with
parents and teachers to develop
individualized healthcare plans. Few
staff are trained to provide service.
Nurse collaborates with parents and
teachers in developing individualized
healthcare plans when asked. Some
staff are trained to provide service.
In addition to standards, the nurse
initiates collaboration with parents,
medical providers and teachers in
developing individualized healthcare
plans. Nurse actively locates
resources for parents, students and
teachers, as appropriate.
□
□
Nurse initiates collaboration with
parents and teachers in
developing individualized
healthcare plan (IHP) for students.
IHP is clear, concise and is
reviewed annually or as needed.
Training and delegation follows
guidelines with at least three
school staff trained.
□
□
EVIDENCE:
3e:
Collaborating with parent and
teachers to develop individualized
healthcare plans (IHP) and
services for students with special
medical needs
EVIDENCE:
18
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 4 FOR NURSES: PROFESSIONAL RESPONSIBILITIES
COMPONENT
4a:
Reflecting on nursing practice
which is based on current
scientific evidence
INEFFECTIVE
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
Nurse's reflection of evidence based
practice is moderately accurate and
objective. Nurse needs development
in analysis of planning and
implementation of school nurse
techniques and practice.
Nurse's reflection provides an
accurate and objective description
of evidence based practice, citing
specific positive and negative
characteristics. Nurse actively
seeks ideas for program
improvement through self-direction
and feedback from colleagues.
Nurse's reflection is highly accurate
and perceptive. Nurse draws on an
extensive repertoire to suggest
alternative strategies to improve
health office activity. Health office
activities support the educational
goals of the school. Nurse serves as
a mentor and engages in professional
activities.
□
□
□
Nurse’s health log, medication
records and immunization records are
generally accurate, but are
occasionally late.
Nurse’s health log, medication
records and immunization records
are accurate and are submitted in a
timely manner.
In addition to meeting the criteria on
this standard, the nurse’s approach to
record keeping is highly systematic
and efficient. Nurse's documentation
serves as a model for colleagues
across the school. Reports are
accurate and timely.
□
□
□
□
Nurse does not communicate clearly
or effectively and in a timely manner
with students, parents and school
personnel.
Nurse makes an effort to
communicate with students, parents,
and school personnel, but these
communications may not always be
made in a timely manner or may
occasionally lack clarity and/or
sensitivity.
Nurse regularly communicates with
students, parents, and school
personnel and these
communications are made in a
timely manner and are delivered
with clarity and sensitivity. The
nurse frequently acts as a resource
person to staff and families.
In addition to meeting the criteria on
this standard, the nurse proactively
consults with families, medical
providers and colleagues.
□
□
□
□
Nurse does not show evidence of
school nurse practice, or the
reflections are inaccurate or selfserving.
□
EVIDENCE:
4b:
Maintaining health records in
accordance with policy and
submitting reports in a timely
fashion
Nurse’s health log, medication
records and immunization records,
are frequently missing, late or
inaccurate.
EVIDENCE:
4c:
Professional communication
EVIDENCE:
19
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
4d:
Maintaining confidentiality
Nurse violates confidentiality of
sensitive issues when dealing with
colleagues or student issues.
□
Nurse appropriately maintains
confidentiality of sensitive issues
when dealing with colleagues or
student issues in most interactions.
□
Nurse appropriately maintains
confidentiality in all interactions.
Nurse is sensitive to issues when
dealing with health related
concerns and provides information
when appropriate.
Nurse maintains confidentiality in all
interactions. Nurse is seen as a
resource and instructs colleagues in
confidentiality rules. Nurse has a clear
understanding of HIPPA and FERPA
laws pertaining to interactions in the
school setting.
□
EVIDENCE:
4e:
Engaging in professional
development
Nurse does not participate in
professional development activities,
even when such activities are clearly
needed for the development of school
nursing skills.
Nurse’s participation in professional
development activities is limited to
those that are convenient or are
required.
Nurse seeks out opportunities for
professional development based
on an individual assessment of
need. Nurse networks with
colleagues to share strategies.
Nurse actively pursues professional
development opportunities and makes
a substantial contribution to the
profession through such activities as
offering workshops to colleagues.
Nurse belongs to professional
organizations for increased continuing
education. Nurse stays up to date
with school nursing journals, articles,
websites.
□
□
□
□
Nurse is not seen as a role model in
the school. Nurse displays dishonesty
in interactions with colleagues,
students, and/or the public, does not
exercise good judgment in
professional settings and does not
have dependable attendance.
Nurse is seen as a role model in
some situations. Nurse is honest in
interactions with colleagues, students,
and/or the public, plays a moderate
advocacy role for students, and
exercises good judgment in
professional settings.
Nurse is seen as a role model in
the school in most interactions.
Nurse displays high standards of
honesty, integrity with interactions
with colleagues, students, and/or
the public. Nurse exercises good
judgment in professional settings
and advocates for students when
needed.
Nurse is consistently seen as a
professional role model by students
and colleagues in the school. Nurse
can be counted on to hold the highest
standards of honesty, integrity,
professional judgment and advocates
for students, taking a leadership role
with colleagues.
□
□
□
□
EVIDENCE:
4f:
Shows professionalism by being a
good role model including
dependable attendance,
punctuality in performance of
duties and professional
appearance.
EVIDENCE:
20
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
Psychologist Performance Evaluation (Form 1B)
Employee:
School Year:
EIN:
School:
Fall Summative Evaluation
Evaluator:
Status:
Probationary
Date:
□
□
Spring Summative Evaluation
Continuing
□
Evaluation
□
□
Self-Review
□
DOMAIN 1 FOR SCHOOL PSYCHOLOGISTS: PLANNING AND PREPARATION
COMPONENT
INEFFECTIVE
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
1a:
Demonstrating knowledge of the
profession of psychology,
including professional, ethical,
and legal standards and
regulations that guide the practice
of psychology in education
School psychologist has limited
knowledge of professional
standards, ethical expectations, and
legal regulations related to the
practice of psychology in the
schools.
School psychologist has a general
knowledge of professional
standards, ethical expectations, and
legal regulations related to the
practice of psychology in the
schools, but requires support to
further develop this knowledge.
School psychologist consistently
practices in ways that
demonstrate knowledge of
professional standards, ethical
expectations, and legal
regulations related to the practice
of psychology.
School psychologist consistently
practices in ways that demonstrate
knowledge of professional
standards, ethical expectations, and
legal regulations related to the
practice of psychology and provides
leadership in sharing such
knowledge with colleagues.
□
□
□
□
School psychologist consistently
demonstrates thorough
knowledge of child and
adolescent development, cultural
diversity, and psycho-pathology.
School psychologist consistently
demonstrates thorough knowledge of
child and adolescent development,
cultural diversity, and psychopathology and provides leadership in
sharing such knowledge with
colleagues.
□
□
EVIDENCE:
1b:
Demonstrating knowledge
of child and adolescent
characteristics, including
knowledge of development,
cultural diversity, and
psychopathology
School psychologist demonstrates
little or no knowledge of child and
adolescent development, cultural
diversity, and/ or psychopathology.
□
School psychologist demonstrates
basic knowledge of child and
adolescent development, cultural
diversity, and/ or psychopathology,
but requires support to further
develop this knowledge.
□
EVIDENCE:
21
1c:
Demonstrating knowledge of
assessment, including selecting
and using a range of
psychological instruments to
evaluate students, linked to
assessment concerns and
potential interventions
School psychologist demonstrates
little or no knowledge and skill in
selecting different psychological
instruments to evaluate students,
tending to select only one or two
instruments regardless of the referral
concern.
School psychologist knows a number
of tests but tends to select a
standard battery for all assessments,
with limited regard to the specific
assessment needs of each case.
□
□
School psychologist selects
different psychological
instruments to evaluate students
based on referral concern and
assessment needs.
□
School psychologist selects from
among a wide range of psychological
instruments to evaluate students,
selecting instruments based on the
referral concern, and linking choice
of assessment tools to potential
interventions.
□
EVIDENCE:
1d:
Demonstrating knowledge of
procedures and resources,
including district procedures,
state and federal regulations,
resources within and beyond the
school and district, and the
continuum of services available to
students
School psychologist demonstrates
little or no knowledge of
governmental regulations or district
procedures or of resources for
students available through the
school, district, and community.
□
School psychologist displays
awareness of governmental
regulations and of most district
procedures and of resources for
students available through the
school or district, but has limited
knowledge of resources available
within the community.
□
EVIDENCE:
22
School psychologist displays
awareness of governmental
regulations and district
procedures and of resources for
students available through the
school or district and the
community.
□
School psychologist’s knowledge of
governmental regulations and district
procedures and of resources for
students is extensive, including
those available through the school or
district and in the community and
takes a leadership role in sharing
that knowledge.
□
1e:
Designing a cohesive service
delivery system that solves
school-wide problems, meets the
needs of individual students, and
includes prevention
School psychologist does not appear
to have an overall plan but instead
provides services in a seemingly
random way, does not use a
problem-solving framework to work
with teachers and colleagues, and/or
is not involved with prevention
activities.
School psychologist implements a
number of worthwhile activities but
does not appear to have a coherent
plan for these, does not consistently
use a problem-solving framework to
meet needs of students, and/or has
limited involvement in prevention
activities.
School psychologist has a
coherent plan for delivering
psychological services in the
school, typically utilizes a
problem-solving approach to
responding to concerns, and is
involved in school-wide activities
focused on prevention of mental
health or learning problems.
School psychologist consistently
utilizes a problem-solving framework
in responding to concerns and
assumes a leadership role in training
and supporting school-wide activities
focused on prevention of mental
health or learning problems.
□
□
□
□
EVIDENCE:
1f:
Demonstrating knowledge of
research-based instructional,
behavioral, and mental health
interventions
School psychologist has little
knowledge of research-based
instructional, behavioral, and/or
mental health interventions.
□
School psychologist has some
knowledge of research-based
instructional, behavioral, and/or
mental health interventions.
□
EVIDENCE:
23
School psychologist
demonstrates knowledge of
research-based instructional,
behavioral, and mental health
interventions.
□
In addition to meeting the effective
standard, the school psychologist
regularly provides feedback
regarding the use of research-based
interventions, supports the
intervention provider, and suggests
modifications if an intervention is not
successful.
□
DOMAIN 2 FOR SCHOOL PSYCHOLOGISTS: THE ENVIRONMENT
COMPONENT
2a:
Maintaining an environment of
respect and rapport in
professional relationships and
with students
INEFFECTIVE
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
School psychologist’s interactions
with students are negative or
inappropriate; school psychologist
rarely engages in collaborative,
effective, and/or ethical professional
relationships.
School psychologist’s interactions
with students are a mix of positive
and negative; the school
psychologist engages in some
collaborative relationships but these
are not always effective and/or
professional/ethical.
School psychologist’s
interactions with students are
positive and respectful; school
psychologist consistently
engages in collaborative,
effective, and ethical professional
relationships.
Students, teachers, and others seek
out the school psychologist,
reflecting a high degree of comfort
and trust in the relationship and
effective collaboration outcomes.
□
□
□
□
School psychologist makes no
attempt to establish a culture of
learning and achievement, does not
use data in making decisions, and
does not promote the use of
research-based interventions.
School psychologist attempts to
establish a culture of learning and
achievement, to use data in making
decisions, and to promote the use of
research-based interventions.
School psychologist consistently
supports a culture of learning and
achievement, uses data in making
decisions, and promotes the use
of research-based interventions.
□
□
□
In addition to meeting the criteria for
effective on this standard, the school
psychologist actively promotes the
culture of learning and achievement
by conducting research, by helping
teachers make better data-based
decisions, and/or by routinely
suggesting changes in interventions
if the data do not support their
effectiveness.
EVIDENCE:
2b:
Supporting a culture of learning
and achievement in classrooms,
by promoting data-based
decision-making and researchbased interventions
EVIDENCE:
24
□
2c:
Implementing clear procedures for
referrals and for working with the
building-level child study process
No procedures for referrals have
been established; when teachers
want to refer a student for special
services, they are not sure how to go
about it. There is no building-level
child study process in place.
School psychologist has established
procedures for referrals, but the
details are not always clear. The
building-level child study process is
ineffective or poorly implemented.
Procedures for referrals and for
meetings and consultations with
parents and administrators are
clear to everyone. The school
psychologist supports the
building-level child study process
by providing training and/or
consultation to the team on a
regular basis.
Procedures for all aspects of referral
and testing protocols are clear to
everyone, have been developed in
consultation with teachers and
administrators, and are regularly
shared with building-level staff. The
building-level child study process
works effectively and the school
psychologist provides on-going
support and training to the team.
□
□
□
□
School psychologist provides some
consultation on behavior problems;
usually considers antecedents,
consequences, and functions of
behavior; and demonstrates a basic
knowledge of principles of positive
behavior supports.
School psychologist regularly
provides consultation on behavior
problems; regularly considers
antecedents, consequences, and
functions of behavior; and
demonstrates knowledge of
principles of positive behavior
supports.
In addition to meeting the effective
criteria for this standard, the school
psychologist is able to help teachers
develop effective positive behavior
intervention plans linked to the
functional behavioral assessment. In
addition, the school psychologist
regularly follows up with the teacher
to assure that the behavior plan is
being implemented with fidelity and
helps modify the behavior plan if
desired changes in the student’s
behavior are not taking place.
□
□
□
EVIDENCE:
2d:
Establishing procedures for
analyzing student behavior and
providing positive behavioral
supports
School psychologist does not
provide consultation on behavior
problems, does not consider
antecedents, consequences, and
functions of behavior, and does not
understand principles of positive
behavior supports.
□
EVIDENCE:
25
2e:
Organizing physical space,
including appropriate testing
space, space to consult with
teachers and parents, and
maintaining confidential storage
for test materials and files
The school psychologist’s workspace
is disorganized and poorly suited to
student evaluations. Materials are
not stored in a secure location and/or
are difficult to find when needed.
The school psychologist’s workspace
is not efficiently organized and
student testing arrangements aren’t
adequate for all children. Materials
usually are stored securely, but may
still be difficult to find when needed.
□
□
EVIDENCE:
26
The school psychologist’s
workspace is well organized;
materials are stored in a secure
location and are available when
needed.
□
The school psychologist’s workspace
is highly organized and is inviting to
students. Materials are stored in a
secure location and are convenient
when needed.
□
DOMAIN 3 FOR SCHOOL PSYCHOLOGISTS: DELIVERY OF SERVICE
COMPONENT
INEFFECTIVE
DEVELOPING
3a:
Communicating effectively by
responding in a timely manner to
referrals, parent requests, and reevaluation schedules; consulting
regularly with teachers and
administrators
School psychologist fails to
communicate clearly, effectively and
in a timely manner with students,
parents, and school personnel.
School psychologist makes an effort
to communicate with students,
parents, and school personnel, but
these communications may not
always be made in a timely manner
or may occasionally lack clarity
and/or sensitivity.
□
□
EFFECTIVE
School psychologist regularly
communicates with students,
parents, and school personnel,
and these communications are
made in a timely manner and are
delivered with clarity and
sensitivity.
HIGHLY EFFECTIVE
In addition to meeting the criteria for
effective on this standard, the school
psychologist proactively seeks
opportunities to share information
with students, parents, and school
personnel.
□
□
School psychologist consistently
collects data from multiple
sources, administers appropriate
evaluation instruments linking the
choice of instruments to the
referral question, and links
assessment to interventions in
general and special education
settings.
In addition to meeting the criteria for
effective on this standard, the school
psychologist assumes a leadership
position in data analysis in order to
improve educational outcomes in
general education and special
education settings.
□
□
EVIDENCE:
3b:
Gathering information
systematically from multiple
sources, using test instruments
appropriately, and considering the
context for assessment and
intervention
School psychologist resists
administering evaluations, selects
instruments inappropriate to the
situation, and/or does not link
selected assessments to the
individual context.
□
School psychologist collects data
from multiple sources and
administers appropriate evaluation.
□
EVIDENCE:
27
3c:
Serving as case manager of the
evaluation team, maintaining
contact with other professionals
throughout the assessment
process, and writing integrated
MET reports
School psychologist rarely assumes
leadership of the evaluation team,
does not work effectively with other
team members, and/or misses
district timelines.
School psychologist assumes
leadership of the evaluation team
and maintains occasional contact
with team members throughout the
assessment process. MET Reports
may not be completed prior to
meetings and other professionals
may or may not have their portions
completed.
School psychologist consistently
assumes leadership of the
evaluation team; assures that all
team members complete their
portions of an assessment plan
and enter data into the MET report
prior to meetings; and assures
that timelines are met.
School psychologist assumes
leadership of the evaluation team
and takes initiative in assembling
materials for meetings. METs are
prepared in advance of meetings
and information from all specialists is
integrated in an exemplary manner.
All timelines are met.
□
□
□
□
School psychologist consistently
provides social skills training,
counseling, and behavioral
coaching and consults with
teachers to develop appropriate
interventions targeted to
assessment outcomes.
In addition to meeting the criteria for
effective on this standard, the school
psychologist assumes a leadership
role that includes teaching teachers
how to incorporate strategies into
their classroom routines and
provides modeling and coaching to
assure that interventions are
implemented with fidelity.
□
□
EVIDENCE:
3d:
Addressing social-emotional
needs of students by providing
social skills training, counseling,
and/or behavioral coaching, and
working with teachers and/or
parents to plan and implement
interventions
School psychologist fails to plan or
deliver interventions suitable to
student needs or suggested
interventions are mismatched with
the findings of the assessments.
□
School psychologist provides some
social skills training and suggests
interventions to teacher but rarely
provides counseling or behavioral
coaching to students.
□
EVIDENCE:
28
3e:
Demonstrating flexibility and
responsiveness
School psychologist adheres to
standard ways of delivering
psychological services in spite of
evidence of its inadequacy. When
leading meetings, can be directive,
inflexible, and unresponsive to other
team members.
School psychologist makes modest
changes in the delivery of
psychological services when
confronted with evidence of the need
for change. Typically asks others to
share information at meetings but
does not always thoughtfully
consider that information in leading
the team to decisions.
School psychologist consistently
reviews and revises the delivery
of psychological services in ways
that are responsive to the needs
of students, families, teachers,
and schools. Consistently
encourages discussion at team
meetings and leads the team to
thoughtfully consider all
information in coming to a
decision.
School psychologist is continually
seeking ways to improve the delivery
of psychological services, making
changes in response to student,
parent, or teacher input. The school
psychologist regularly shares
expertise at the school, department,
and/or district level. Is an advocate
of team decision making, soliciting
multiple views and leading the team
to thoughtfully consider all
information in coming to a decision.
□
□
□
□
EVIDENCE:
29
DOMAIN 4 FOR SCHOOL PSYCHOLOGISTS: PROFESSIONAL RESPONSIBILITIES
COMPONENT
4a:
Reflecting on practice
INEFFECTIVE
School psychologist does not reflect
on practice, or the reflections are
inaccurate or self-serving.
□
DEVELOPING
School psychologist’s reflection on
practice is moderately accurate and
objective without citing specific
examples, and with only global
suggestions as to how it might be
improved.
□
EFFECTIVE
HIGHLY EFFECTIVE
School psychologist’s reflection
provides an accurate and
objective description of practice,
citing specific positive and
negative characteristics. School
psychologist makes some specific
suggestions as to how delivery of
psychological services might be
improved.
School psychologist’s reflection is
highly accurate and perceptive, citing
specific examples of interventions
that were not fully successful for at
least some students. School
psychologist draws on an extensive
repertoire to suggest alternative
strategies.
□
□
School psychologist’s records are
accurate and legible, well
organized, and stored in a secure
location. Case files are
consistently submitted in keeping
with district guidelines. MET
reports are written in a way that
parents and teachers find them to
be useful.
In addition to meeting the criteria for
effective on this standard, case files
are always submitted in keeping with
district guidelines, deadlines are
always met, and MET reports are
complete, well-written, edited, and
understandable.
□
□
EVIDENCE:
4b:
Maintaining accurate records
School psychologist’s records are in
disarray; components may be
missing, illegible, or stored in an
insecure location; case files are
inconsistently submitted to special
education records for scanning.
□
School psychologist’s records are
accurate and legible and are stored
in a secure location. Case files are
usually submitted in keeping with
district guidelines.
□
EVIDENCE:
30
4c:
Communicating with families
School psychologist’s
communication with families is
partially successful; permissions are
obtained, but there are occasional
insensitivities to cultural and
linguistic traditions.
School psychologist consistently
communicates with families and
secures necessary permission for
evaluations and does so in a
manner that is sensitive to
cultural and linguistic traditions.
□
□
□
□
School psychologist’s relationships
with colleagues are negative or selfserving, and school psychologist
avoids being involved in school and
district events and projects.
School psychologist’s relationships
with colleagues are cordial, and
school psychologist participates in
school and district events and
projects when specifically requested
to do so.
School psychologist participates
actively in school and district
events and projects and maintains
positive and productive
relationships with colleagues.
Occasionally takes on a
mentoring role with colleagues
new to the profession or district.
School psychologist makes a
substantial contribution to school and
district events and projects and
assumes leadership with colleagues.
Often takes on a mentoring role with
colleagues new to the profession or
district.
□
□
□
□
School psychologist rarely
participates in professional
development activities, even when
such activities are clearly needed for
the ongoing development of skills.
School psychologist’s participation in
professional development activities
is limited to those that are
convenient or are required.
□
□
School psychologist fails to
communicate with families and
secure necessary permission for
evaluations or communicates in an
insensitive manner.
School psychologist secures
necessary permissions and
communicates with families in a
manner highly sensitive to cultural
and linguistic traditions. School
psychologist reaches out to families
of students to enhance trust.
EVIDENCE:
4d:
Participating in professional
communities, including those
established at assigned schools
and with school psychologist
colleagues
EVIDENCE:
4e:
Growing and developing
professionally
EVIDENCE:
31
School psychologist seeks out
opportunities for professional
development based on an
individual assessment of need.
□
School psychologist actively pursues
professional development
opportunities and makes a
substantial contribution to the
profession through such activities as
offering workshops to colleagues.
□
4f:
Demonstrating professionalism
School psychologist sometimes
displays dishonesty in interactions
with colleagues, students, and/or the
public, does not exercise good
judgment in professional settings,
and/or violates principles of
confidentiality.
School psychologist is honest in
interactions with colleagues,
students, and the public, plays a
moderate advocacy role for students,
exercises good judgment in
professional settings, and does not
violate confidentiality.
School psychologist displays high
standards of honesty, integrity,
and confidentiality in interactions
with colleagues, students, and the
public; exercises good judgment
in professional settings; and
advocates for students when
needed.
School psychologist can be counted
on to hold the highest standards of
honesty, integrity, professional
judgment, and confidentiality and to
advocate for students, taking a
leadership role with colleagues.
□
□
□
□
EVIDENCE:
32
Instructional Specialist Performance Evaluation (Form 1C)
Employee:
School Year:
EIN:
School:
Fall Summative Evaluation
Evaluator:
Status:
Probationary
Date:
□
□
Spring Summative Evaluation
Continuing
□
Evaluation
□
□
Self-Review
□
DOMAIN 1 FOR INSTRUCTIONAL SPECIALISTS: PLANNING AND PREPARATION
COMPONENT
1a:
Demonstrating knowledge of
current trends in specialty
area and professional
development
INEFFECTIVE
DEVELOPING
EFFECTIVE
Instructional specialist demonstrates
little or no familiarity with specialty
area or trends in professional
development.
Instructional specialist demonstrates
basic familiarity with specialty area
and trends in professional
development.
□
□
Instructional specialist demonstrates
little or no knowledge of the school’s
program or of teacher skill in
delivering that program.
Instructional specialist demonstrates
basic knowledge of the school’s
program and of teacher skill in
delivering that program.
□
□
Instructional specialist
demonstrates thorough
knowledge of specialty area and
trends in professional
development.
□
HIGHLY EFFECTIVE
Instructional specialist’s knowledge
of specialty area and trends in
professional development is wide
and deep; specialist is regarded as
an expert by colleagues.
□
EVIDENCE:
1b:
Demonstrating knowledge of the
school’s program and levels of
teacher skill in delivering that
program
Instructional specialist
demonstrates thorough
knowledge of the school’s
program and of teacher skill in
delivering that program.
□
Instructional specialist is deeply
familiar with the school’s program
and works to shape its future
direction and actively seeks
information as to teacher skill in that
program.
□
EVIDENCE:
33
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1c:
Establishing goals for the
instructional support program
appropriate to the setting and the
teachers served
Instructional specialist has no clear
goals for the instructional support
program, or they are inappropriate to
either the situation or the needs of
the staff.
Instructional specialist’s goals for the
instructional support program are
rudimentary and are partially suitable
to the situation and the needs of the
staff.
Instructional specialist’s goals for
the instructional support program
are clear and are suitable to the
situation and the needs of the
staff.
Instructional specialist’s goals for the
instructional support program are
highly appropriate to the situation
and the needs of the staff. They
have been developed following
consultations with administrators and
colleagues.
□
□
□
□
Instructional specialist demonstrates
little or no knowledge of resources
available in the school or district for
teachers to advance their skills.
Instructional specialist demonstrates
basic knowledge of resources
available in the school and district for
teachers to advance their skills.
Instructional specialist is fully
aware of resources available in
the school and district and in the
larger professional community for
teachers to advance their skills.
Instructional specialist actively seeks
out new resources from a wide range
of sources to enrich teachers’ skills
in implementing the school’s
program.
□
□
□
□
Instructional specialist’s plan is
well designed to support teachers
in the improvement of their
instructional skills.
Instructional specialist’s plan
is highly coherent, taking
into account the competing demands
of making presentations and
consulting with teachers, and has
been developed following
consultation with administrators and
teachers.
□
□
EVIDENCE:
1d:
Demonstrating knowledge of
resources, both within and
beyond the school and district
EVIDENCE:
1e:
Planning the instructional support
program, integrated with the
overall school program
Instructional specialist’s plan
consists of a random collection of
unrelated activities, lacking
coherence or an overall structure.
□
Instructional specialist’s plan has a
guiding principle and includes a
number of worthwhile activities, but
some of them don’t fit with the
broader goals.
□
EVIDENCE:
34
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1f:
Developing a plan to evaluate the
instructional support program
Instructional specialist has no plan to
evaluate the program or resists
suggestions that such an evaluation
is important.
□
Instructional specialist has a
rudimentary plan to evaluate the
instructional support program.
□
Instructional support specialist’s
plan to evaluate the program is
organized around clear goals and
the collection of evidence to
indicate the degree to which the
goals have been met.
Instructional specialist’s evaluation
plan is highly sophisticated, with
imaginative sources of evidence and
a clear path toward improving the
program on an ongoing basis.
□
□
EVIDENCE:
35
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 2 FOR INSTRUCTIONAL SPECIALISTS: THE ENVIRONMENT
COMPONENT
2a:
Creating an environment of
trust and respect
INEFFECTIVE
Teachers are reluctant to request
assistance from the instructional
specialist, fearing that such a
request will be treated as a sign of
deficiency.
□
DEVELOPING
EFFECTIVE
Relationships with the instructional
specialist are cordial; teachers don’t
resist initiatives established by the
instructional specialist.
□
Relationships with the
instructional specialist are
respectful, with some contacts
initiated by teachers.
HIGHLY EFFECTIVE
Relationships with the instructional
specialist are highly respectful and
trusting, with many contacts initiated
by teachers.
□
□
Instructional specialist promotes
a culture of professional inquiry in
which teachers seek assistance in
improving their instructional
skills.
Instructional specialist has
established a culture of professional
inquiry in which teachers initiate
projects to be undertaken with the
support of the specialist.
□
□
□
Some procedures (for example,
registering for workshops) are clear
to teachers, whereas others (for
example, receiving informal support)
are not.
Instructional specialist has
established clear procedures for
teachers to use in gaining access
to support.
□
□
EVIDENCE:
2b:
Establishing a culture for ongoing
instructional improvement
Instructional specialist conveys the
sense that the work of improving
instruction is externally mandated
and is not important to school
improvement.
□
Teachers do not resist the offerings
of support from the instructional
specialist.
EVIDENCE:
2c:
Establishing clear procedures for
teachers to gain access to
instructional support
When teachers want to access
assistance from the instructional
specialist, they are not sure how
to go about it.
□
Procedures for access to
instructional support are clear to all
teachers and have been developed
following consultation with
administrators and teachers.
□
EVIDENCE:
36
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
2d:
Establishing and maintaining
norms of behavior for
professional interactions
No norms of professional conduct
have been established; teachers are
frequently disrespectful in their
interactions with one another.
□
Instructional specialist’s efforts to
establish norms of professional
conduct are partially successful.
□
Instructional specialist has
established clear norms of mutual
respect for professional
interaction.
□
Instructional specialist has
established clear norms of mutual
respect for professional interaction.
Teachers ensure that their
colleagues adhere to these
standards of conduct.
□
EVIDENCE:
2e:
Organizing physical space for
workshops or training
Instructional specialist makes poor
use of the physical environment,
resulting in poor access by some
participants, time lost due to poor
use of training equipment, or little
alignment between the physical
arrangement and the workshop
activities.
□
The physical environment does not
impede workshop activities.
□
Instructional specialist makes
good use of the physical
environment, resulting in
engagement of all participants in
the workshop activities.
□
Instructional specialist makes highly
effective use of the physical
environment, with teachers
contributing to the physical
arrangement.
□
EVIDENCE:
37
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 3 FOR INSTRUCTIONAL SPECIALISTS: DELIVERY OF SERVICE
COMPONENT
INEFFECTIVE
3a:
Collaborating with teachers in the
design of instructional units and
lessons
Instructional specialist declines to
collaborate with classroom teachers
in the design of instructional lessons
and units.
□
DEVELOPING
EFFECTIVE
Instructional specialist collaborates
with classroom teachers in the
design of instructional lessons and
units when specifically asked to do
so.
Instructional specialist initiates
collaboration with classroom
teachers in the design of
instructional lessons and units.
HIGHLY EFFECTIVE
Instructional specialist initiates
collaboration with classroom
teachers in the design of
instructional lessons and units,
locating additional resources from
sources outside the school.
□
□
□
Instructional specialist’s efforts to
engage teachers in professional
learning are partially successful, with
some participating.
All teachers are engaged in
acquiring new instructional skills.
Teachers are highly engaged in
acquiring new instructional skills and
take initiative in suggesting new
areas for growth.
□
□
□
□
Instructional specialist’s model
lessons and workshops are of poor
quality or are not appropriate to the
needs of the teachers being served.
The quality of the instructional
specialist’s model lessons and
workshops is mixed, with some of
them being appropriate to the needs
of the teachers being served.
□
□
EVIDENCE:
3b:
Engaging teachers in learning
new instructional skills
Teachers decline opportunities to
engage in professional learning.
EVIDENCE:
3c:
Sharing expertise with staff
The quality of the instructional
specialist’s model lessons and
workshops is uniformly high and
appropriate to the needs of the
teachers being served.
□
The quality of the instructional
specialist’s model lessons and
workshops is uniformly high and
appropriate to the needs of the
teachers being served. The
instructional specialist conducts
extensive follow-up work with
teachers.
□
EVIDENCE:
38
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
3d:
Locating resources for teachers to
support instructional
improvement
Instructional specialist fails to locate
resources for instructional
improvement for teachers, even
when specifically requested to do so.
□
Instructional specialist’s efforts to
locate resources for instructional
improvement for teachers are
partially successful, reflecting
incomplete knowledge of what is
available.
□
Instructional specialist locates
resources for instructional
improvement for teachers when
asked to do so.
□
Instructional specialist is highly
proactive in locating resources for
instructional improvement for
teachers, anticipating their needs.
□
EVIDENCE:
3e:
Demonstrating flexibility and
responsiveness
Instructional specialist adheres to his
plan, in spite of evidence of its
inadequacy.
□
Instructional specialist makes
modest changes in the support
program when confronted with
evidence of the need for change.
□
Instructional specialist makes
revisions to the support program
when it is needed.
□
Instructional specialist is continually
seeking ways to improve the support
program and makes changes as
needed in response to student,
parent, or teacher input.
□
EVIDENCE:
39
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 4 FOR INSTRUCTIONAL SPECIALISTS: PROFESSIONAL RESPONSIBILITIES
COMPONENT
4a:
Reflecting on practice
INEFFECTIVE
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
Instructional specialist does not
reflect on practice, or the reflections
are inaccurate or self-serving.
Instructional specialist’s reflection on
practice is moderately accurate and
objective without citing specific
examples and with only global
suggestions as to how it might be
improved.
Instructional specialist’s reflection
provides an accurate and
objective description of practice,
citing specific positive and
negative characteristics.
Instructional specialist makes
some specific suggestions as to
how the support program might
be improved.
Instructional specialist’s reflection is
highly accurate and perceptive, citing
specific examples. Instructional
specialist draws on an extensive
repertoire to suggest alternative
strategies, accompanied by a
prediction of the likely consequences
of each.
□
□
□
□
Instructional specialist adheres to
law, policy, regulation and
procedures required for the
position. Specialist completes
budgets, plans and reports
accurately and in a timely manner,
as directed.
Instructional specialist anticipates,
with limited or no direction,
responsibilities related to law, policy,
regulation and procedures required
for the position. Specialist
completes budgets, plans and
reports accurately and in a timely
manner.
□
□
EVIDENCE:
4b:
Compliance and reporting
Instructional specialist does not
follow established law, policy,
regulations or procedures. Reports,
budgets or other required routines
are not completed correctly or are
routinely late.
□
Instructional specialist’s efforts to
adhere to law, policy, regulations or
procedures are partially successful.
Reports, budgets or other required
routines are completed with
assistance from others.
□
EVIDENCE:
40
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
4c:
Coordinating work with other
instructional specialists
Instructional specialist makes no
effort to collaborate with other
instructional specialists within the
district.
Instructional specialist responds
positively to the efforts of other
instructional specialists within the
district to collaborate.
Instructional specialist initiates
efforts to collaborate with other
instructional specialists within the
district.
Instructional specialist takes a
leadership role in coordinating
projects with other instructional
specialists within and beyond the
district.
□
□
□
□
Instructional specialist’s relationships
with colleagues are negative or selfserving, and the specialist avoids
being involved in school and district
events and projects.
Instructional specialist’s relationships
with colleagues are cordial, and the
specialist participates in school and
district events and projects when
specifically requested.
Instructional specialist
participates actively in school and
district events and projects and
maintains positive and productive
relationships with colleagues.
Instructional specialist makes a
substantial contribution to school and
district events and projects and
assumes a leadership role with
colleagues.
□
□
□
□
Instructional specialist does not
participate in professional
development activities, even when
such activities are clearly needed for
the enhancement of skills.
Instructional specialist’s participation
in professional development
activities is limited to those that are
convenient or are required.
□
□
EVIDENCE:
4d:
Participating in a professional
community
EVIDENCE:
4e:
Engaging in professional
development
Instructional specialist seeks out
opportunities for professional
development based on an
individual assessment of need.
□
Instructional specialist actively
pursues professional development
opportunities and makes a
substantial contribution to the
profession through such activities as
participating in state or national
conferences for other specialists.
□
EVIDENCE:
41
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
4f:
Showing professionalism,
including integrity and
confidentiality
Instructional specialist displays
dishonesty in interactions with
colleagues and violates norms of
confidentiality.
□
Instructional specialist is honest in
interactions with colleagues and
respects norms of confidentiality.
□
Instructional specialist displays
high standards of honesty and
integrity in interactions with
colleagues and respects norms of
confidentiality.
□
Instructional specialist can be
counted on to hold the highest
standards of honesty and integrity
and takes a leadership role with
colleagues in respecting the norms
of confidentiality.
□
EVIDENCE:
42
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
Therapeutic Specialist Performance Evaluation (Form 1D)
Employee:
School Year:
EIN:
School:
Fall Summative Evaluation
Evaluator:
Status:
Probationary
Date:
□
□
Spring Summative Evaluation
Continuing
□
Evaluation
□
□
Self-Review
□
DOMAIN 1 FOR THERAPEUTIC SPECIALISTS: PLANNING AND PREPARATION
COMPONENT
1a:
Demonstrating knowledge and
skill in the specialist therapy area;
holding the relevant certificate or
license
INEFFECTIVE
Specialist demonstrates little or no
knowledge and skill in the therapy
area; does not hold the necessary
certificate or license.
□
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
Specialist demonstrates basic
knowledge and skill in the therapy
area; holds the necessary certificate
or license.
Specialist demonstrates thorough
knowledge and skill in the therapy
area; holds the necessary
certificate or license.
□
□
□
Specialist’s goals for the therapy
program are rudimentary and are
partially suitable to the situation and
to the age of the students.
Specialist’s goals for the therapy
program are clear and appropriate
to the situation in the school and
to the age of the students.
Specialist’s goals for the therapy
program are highly appropriate to the
situation in the school and to the age
of the students and have been
developed following consultations
with administrators and teachers.
□
□
□
Specialist demonstrates extensive
knowledge and skill in the therapy
area; holds an advanced certificate
or license.
EVIDENCE:
1b:
Establishing goals for the therapy
program appropriate to the setting
and the students served
Specialist has no clear goals for the
therapy program, or they are
inappropriate to either the situation
or the age of the students.
□
EVIDENCE:
43
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1c:
Demonstrating knowledge of
district, state, and federal
regulations and guidelines
Specialist’s knowledge of special
education laws and procedures is
extensive; specialist takes a
leadership role in reviewing and
revising district policies.
Specialist demonstrates little or no
knowledge of special education laws
and procedures.
Specialist demonstrates basic
knowledge of special education laws
and procedures.
Specialist demonstrates thorough
knowledge of special education
laws and procedures.
□
□
□
□
Specialist demonstrates little or no
knowledge of resources for students
available through the school or
district.
Specialist demonstrates basic
knowledge of resources for students
available through the school or
district.
Specialist demonstrates thorough
knowledge of resources for
students available through the
school or district and some
familiarity with resources outside
the district.
Specialist demonstrates extensive
knowledge of resources for students
available through the school or
district and in the larger community.
□
□
□
□
EVIDENCE:
1d:
Demonstrating knowledge of
resources, both within and
beyond the school and district
EVIDENCE:
1e:
Planning the therapy program,
integrated with the regular school
program, to meet the needs of
individual students
Therapy program consists of a
random collection of unrelated
activities, lacking coherence or an
overall structure.
□
Specialist’s plan has a guiding
principle and includes a number of
worthwhile activities, but some of
them don’t fit with the broader goals.
□
Specialist has developed a plan
that includes the important
aspects of work in the setting.
□
Specialist’s plan is highly coherent
and preventive and serves to support
students individually, within the
broader educational program.
□
EVIDENCE:
44
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1f:
Developing a plan to evaluate the
therapy program
Specialist has no plan to evaluate
the program or resists suggestions
that such an evaluation is important.
Specialist has a rudimentary plan to
evaluate the therapy program.
Specialist’s plan to evaluate the
program is organized around clear
goals and the collection of
evidence to indicate the degree to
which the goals have been met.
Specialist’s evaluation plan is highly
sophisticated, with imaginative
sources of evidence and a clear path
toward improving the program on an
ongoing basis.
□
□
□
□
EVIDENCE:
45
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 2 FOR THERAPEUTIC SPECIALISTS: THE ENVIRONMENT
COMPONENT
2a:
Establishing rapport with students
INEFFECTIVE
Specialist’s interactions with
students are negative or
inappropriate; students appear
uncomfortable in the testing and
treatment center.
□
DEVELOPING
EFFECTIVE
Specialist’s interactions are a mix of
positive and negative; the specialist’s
efforts at developing rapport are
partially successful.
□
Specialist’s interactions with
students are positive and
respectful; students appear
comfortable in the testing and
treatment center.
□
HIGHLY EFFECTIVE
Students seek out the specialist,
reflecting a high degree of comfort
and trust in the relationship.
□
EVIDENCE:
2b:
Organizing time effectively
Specialist exercises poor judgment
in setting priorities, resulting in
confusion, missed deadlines, and
conflicting schedules.
□
Specialist’s time-management skills
are moderately well developed;
essential activities are carried out,
but not always in the most efficient
manner.
□
Specialist exercises good
judgment in setting priorities,
resulting in clear schedules and
important work being
accomplished in an efficient
manner.
□
Specialist demonstrates excellent
time-management skills,
accomplishing all tasks in a
seamless manner; teachers and
students understand their schedules.
□
EVIDENCE:
2c:
Establishing and maintaining
clear procedures for referrals
No procedures for referrals have
been established; when teachers
want to refer a student for special
services, they are not sure how to go
about it.
□
Specialist has established
procedures for referrals, but the
details are not always clear.
□
Procedures for referrals and for
meetings and consultations with
parents and administrators are
clear to everyone.
□
Procedures for all aspects of referral
and testing protocols are clear to
everyone and have been developed
in consultation with teachers and
administrators.
□
EVIDENCE:
46
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
2d:
Establishing standards of conduct
in the treatment center
No standards of conduct have been
established, and specialist
disregards or fails to address
negative student behavior during
evaluation or treatment.
Standards of conduct appear to have
been established for the testing and
treatment center. Specialist’s
attempts to monitor and correct
negative student behavior during
evaluation and treatment are partially
successful.
Standards of conduct have been
established for the testing and
treatment center. Specialist
monitors student behavior against
those standards; response to
students is appropriate and
respectful
□
□
□
Standards of conduct have been
established for the testing and
treatment center. Specialist’s
monitoring of students is subtle and
preventive, and students engage in
self-monitoring of behavior.
□
EVIDENCE:
2e:
Organizing physical space for
testing of students and providing
therapy
The testing and treatment center is
disorganized and poorly suited to
working with students. Materials are
usually available.
□
The testing and treatment center is
moderately well organized and
moderately well suited to working
with students. Materials are difficult
to find when needed.
□
The testing and treatment center
is well organized; materials are
available when needed.
□
The testing and treatment center is
highly organized and is inviting to
students. Materials are convenient
when needed.
□
EVIDENCE:
47
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 3 FOR THERAPEUTIC SPECIALISTS: DELIVERY OF SERVICE
COMPONENT
3a:
Responding to referrals and
evaluating student needs
INEFFECTIVE
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
Specialist fails to respond to referrals
or makes hasty assessments of
student needs.
Specialist responds to referrals when
pressed and makes adequate
assessments of student needs.
Specialist responds to referrals
and makes thorough assessments
of student needs.
Specialist is proactive in responding
to referrals and makes highly
competent assessments of student
needs.
□
□
□
□
EVIDENCE:
3b:
Developing and implementing
treatment plans to maximize
students’ success
Specialist fails to develop treatment
plans suitable for students, or plans
are mismatched with the findings of
assessments.
□
Specialist’s plans for students are
partially suitable for them or
sporadically aligned with identified
needs.
□
Specialist’s plans for students are
suitable for them and are aligned
with identified needs.
Specialist develops comprehensive
plans for students, finding ways to
creatively meet student needs and
incorporate many related elements.
□
□
Specialist communicates with
families and secures necessary
permission for evaluations, doing
so in a manner sensitive to
cultural and linguistic traditions.
Specialist secures necessary
permissions and communicates with
families in a manner highly sensitive
to cultural and linguistic traditions.
Specialist reaches out to families of
students to enhance trust.
□
□
EVIDENCE:
3c:
Communicating with families
Specialist fails to communicate with
families and secure necessary
permission for evaluations or
communicates in an insensitive
manner.
□
Specialist’s communication with
families is partially successful;
permissions are obtained, but there
are occasional insensitivities to
cultural and linguistic traditions.
□
EVIDENCE:
48
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
3d:
Collecting information; writing
reports
Specialist neglects to collect
important information on which to
base treatment plans; reports are
inaccurate or not appropriate to the
audience.
□
Specialist collects most of the
important information on which to
base treatment plans; reports are
accurate but lacking in clarity and not
always appropriate to the audience.
Specialist collects all the
important information on which to
base treatment plans; reports are
accurate and appropriate to the
audience.
□
□
Specialist makes modest changes in
the treatment program when
confronted with evidence of the need
for change.
Specialist makes revisions in the
treatment program when they are
needed.
□
□
Specialist is proactive in collecting
important information, interviewing
teachers and parents if necessary;
reports are accurate and clearly
written and are tailored for the
audience.
□
EVIDENCE:
3e:
Demonstrating flexibility and
responsiveness
Specialist adheres to the plan or
program, in spite of evidence of its
inadequacy.
□
Specialist is continually seeking
ways to improve the treatment
program and makes changes as
needed in response to student,
parent, or teacher input.
□
EVIDENCE:
49
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 4 FOR THERAPEUTIC SPECIALISTS: PROFESSIONAL RESPONSIBILITIES
COMPONENT
4a:
Reflecting on practice
INEFFECTIVE
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
Specialist’s reflection on practice is
moderately accurate and objective
without citing specific examples, and
with only global suggestions as to
how it might be improved.
Specialist’s reflection provides an
accurate and objective description
of practice, citing specific positive
and negative characteristics.
Specialist makes some specific
suggestions as to how the therapy
program might be improved.
Specialist’s reflection is highly
accurate and perceptive, citing
specific examples that were not fully
successful for at least some
students. Specialist draws on an
extensive repertoire to suggest
alternative strategies.
□
□
□
□
Specialist is not available to staff for
questions and planning and declines
to provide background material when
requested.
Specialist is available to staff for
questions and planning and provides
background material when
requested.
Specialist initiates contact with
teachers and administrators to
confer regarding individual cases.
□
□
□
Specialist’s data-management
system is either nonexistent or in
disarray; it cannot be used to monitor
student progress or to adjust
treatment when needed.
Specialist has developed a
rudimentary data-management
system for monitoring student
progress and occasionally uses it to
adjust treatment when needed.
□
□
Specialist does not reflect on
practice, or the reflections are
inaccurate or self-serving.
EVIDENCE:
4b:
Collaborating with teachers and
administrators
Specialist seeks out teachers and
administrators to confer regarding
cases, soliciting their perspectives
on individual students.
□
EVIDENCE:
4c:
Maintaining an effective datamanagement system
Specialist has developed an
effective data-management
system for monitoring student
progress and uses it to adjust
treatment when needed.
□
Specialist has developed a highly
effective data-management system
for monitoring student progress and
uses it to adjust treatment when
needed. Specialist uses the system
to communicate with teachers and
parents.
□
EVIDENCE:
50
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
4d:
Participating in a professional
community
Specialist’s relationships with
colleagues are negative or selfserving, and specialist avoids being
involved in school and district events
and projects.
Specialist’s relationships with
colleagues are cordial, and specialist
participates in school and district
events and projects when specifically
asked to do so.
Specialist participates actively in
school and district events and
projects and maintains positive
and productive relationships with
colleagues.
□
□
□
□
Specialist seeks out opportunities
for professional development
based on an individual
assessment of need.
Specialist actively pursues
professional development
opportunities and makes a
substantial contribution to the
profession through such activities as
offering workshops to colleagues.
□
□
Specialist displays high standards
of honesty, integrity, and
confidentiality in interactions with
colleagues, students, and the
public and advocates for students
when needed.
Specialist can be counted on to hold
the highest standards of honesty,
integrity, and confidentiality and to
advocate for students, taking a
leadership role with colleagues.
□
□
Specialist makes a substantial
contribution to school and district
events and projects and assumes a
leadership role with colleagues.
EVIDENCE:
4e:
Engaging in professional
development
Specialist does not participate in
professional development activities,
even when such activities are clearly
needed for the development of skills.
□
Specialist’s participation in
professional development activities
is limited to those that are
convenient or are required.
□
EVIDENCE:
4f:
Showing professionalism,
including integrity, advocacy, and
maintaining confidentiality
Specialist displays dishonesty in
interactions with colleagues,
students, and the public and violates
principles of confidentiality.
□
Specialist is honest in interactions
with colleagues, students, and the
public, plays a moderate advocacy
role for students, and does not
violate norms of confidentiality.
□
EVIDENCE:
51
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
Student Advisor Performance Evaluation (Form 1E)
Employee:
School Year:
EIN:
School:
Fall Summative Evaluation
Evaluator:
Status:
Probationary
Date:
□
□
Spring Summative Evaluation
Continuing
□
Evaluation
□
□
Self-Review
□
DOMAIN 1 FOR STUDENT ADVISORS: GRADUATION/COLLEGE & CAREER READINESS (PLANNING AND PREPARATION)
COMPONENT
1a:
Develop and implement strategies
to facilitate successful transition
from eighth grade to high school
INEFFECTIVE
Limited ability to develop and
implement strategies to facilitate
successful transition from eighth
grade to high school.
DEVELOPING
EFFECTIVE
Inconsistently demonstrates the
ability to develop and implement
strategies to facilitate successful
transition from eighth grade to high
school.
Consistently demonstrates the
ability to develop and implement
strategies to facilitate successful
transition from eighth grade to
high school.
HIGHLY EFFECTIVE
Demonstrates the ability to develop
and implement strategies to facilitate
successful transition from eighth
grade to high school in a competent
and deliberate manner.
□
□
□
□
Rarely monitors students’ academic
progress and provide personalized
guidance, including transcript
evaluation, and support to those who
are not on track to graduate within
four years. Develop and implement
student-specific and system-level
strategies that increase the schools’
rate of graduation and
postsecondary enrollment.
Inconsistently monitors students’
academic progress and provide
personalized guidance, including
transcript evaluation, and support to
those who are not on track to
graduate within four years. Develop
and implement student-specific and
system-level strategies that increase
the schools’ rate of graduation and
postsecondary enrollment.
Regularly monitors students’
academic progress and provide
personalized guidance, including
transcript evaluation, and support
to those who are not on track to
graduate within four years.
Develop and implement studentspecific and system-level
strategies that increase the
schools’ rate of graduation and
postsecondary enrollment.
Consistently monitors students’
academic progress and provide
personalized guidance, including
transcript evaluation, and support to
those who are not on track to
graduate within four years. Develop
and implement student-specific and
system-level strategies that increase
the schools’ rate of graduation and
postsecondary enrollment.
□
□
□
□
EVIDENCE:
1b:
Monitor students’ academic
progress and provide
personalized guidance, including
transcript evaluation, and support
to those who are not on track to
graduate within four years.
Develop and implement studentspecific and system-level
strategies that increase the
schools’ rate of graduation and
postsecondary enrollment
EVIDENCE:
52
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1c:
In collaboration with
administrators and faculty
members, develop and implement
intervention strategies for
students who demonstrate
absentee, behavioral, or academic
issues
Does not collaborate with
administrators and faculty members
to develop and implement
intervention strategies for students
who demonstrate absentee,
behavioral, or academic issues.
□
Occasionally collaborates with
administrators and faculty members
to develop and implement
intervention strategies for students
who demonstrate absentee,
behavioral, or academic issues.
Collaborates with administrators
and faculty members to develop
and implement intervention
strategies for students who
demonstrate absentee, behavioral,
or academic issues.
Continually collaborates with
administrators and faculty members
to develop and implement
intervention strategies for students
who demonstrate absentee,
behavioral, or academic issues.
□
□
□
Occasionally collaborates with
students, teachers and parents to
ensure that each student develops
an ECAP specific to his/her interests,
talents and aspirations. Modify
students’ schedules and courses of
study when appropriate.
Collaborates with students,
teachers and parents to ensure
that each student develops an
ECAP specific to his/her interests,
talents and aspirations. Modify
students’ schedules and courses
of study when appropriate.
Continually collaborates with
students, teachers and parents to
ensure that each student develops
an ECAP specific to his/her interests,
talents and aspirations. Modify
students’ schedules and courses of
study when appropriate.
□
□
□
EVIDENCE:
1d:
In collaboration with students,
teachers and parents, ensure that
each student develops an ECAP
specific to his/her interests,
talents and aspirations. Modify
students’ schedules and courses
of study when appropriate
Rarely collaborates with students,
teachers and parents to ensure that
each student develops an ECAP
specific to his/her interests, talents
and aspirations. Modify students’
schedules and courses of study
when appropriate
□
EVIDENCE:
1e:
Provide ongoing exposure to the
information and experiences
necessary to make informed
decisions when selecting a
postsecondary program or career
Does not provide ongoing exposure
to the information and experiences
necessary to make informed
decisions when selecting a
postsecondary program or career.
□
Provides ongoing exposure to the
information and experiences
necessary to make informed
decisions when selecting a
postsecondary program or career.
□
Consistently provides ongoing
exposure to the information and
experiences necessary to make
informed decisions when
selecting a postsecondary
program or career.
□
Continually provides ongoing
exposure to the information and
experiences necessary to make
informed decisions when selecting a
postsecondary program or career.
□
EVIDENCE:
53
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1f:
Assist students in establishing
postsecondary goals and
successfully completing a high
school course of study that
prepares them to meet those goals
Minimally assists students in
establishing postsecondary goals
and successfully completing a high
school course of study that prepares
them to meet those goals.
Periodically assists students in
establishing postsecondary goals
and successfully completing a high
school course of study that prepares
them to meet those goals.
Regularly assists students in
establishing postsecondary goals
and high school course of study
that prepares them to meet those
goals.
Continually assists students in
establishing postsecondary goals
and successfully completing a high
school course of study that
prepares them to meet those goals.
□
□
□
□
Regularly promotes preparation
for and participation in college
and career assessments such as
the PSAT/NMSQT, ASVAB,
ACCUPLACER, SAT and ACT.
Regularly facilitates students’
understanding of results and how
this information can be applied to
course selection and skill
development.
Continuously promotes preparation
for and participation in college and
career assessments such as the
PSAT/NMSQT, ASVAB,
ACCUPLACER, SAT and ACT.
Continuously facilitates students’
understanding of results and how
this information can be applied to
course selection and skill
development.
□
□
EVIDENCE:
1g:
Promote preparation for and
participation in college and career
assessments such as the
PSAT/NMSQT, ASVAB,
ACCUPLACER, SAT and ACT.
Facilitate students’ understanding
of results and how this information
can be applied to course selection
and skill development
Does not promote preparation for
and participation in college and
career assessments such as the
PSAT/NMSQT, ASVAB,
ACCUPLACER, SAT and ACT.
Does not facilitate students’
understanding of results and how
this information can be applied to
course selection and skill
development.
□
Occasionally promotes preparation
for and participation in college and
career assessments such as the
PSAT/NMSQT, ASVAB,
ACCUPLACER, SAT and ACT.
Occasionally facilitates students’
understanding of results and how
this information can be applied to
course selection and skill
development.
□
EVIDENCE:
54
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1h:
Provide students and families with
comprehensive information about
college expenses. Help students
and families successfully navigate
financial aid and scholarship
processes enabling them to plan
and prepare for postsecondary
educational expenses. Provide
coaching, consultation and direct
services as appropriate
Rarely provides students and
families with comprehensive
information about college expenses.
Helps students and families
successfully navigate financial aid
and scholarship processes enabling
them to plan and prepare for
postsecondary educational
expenses. Provide coaching,
consultation and direct services as
appropriate.
Irregularly provides students and
families with comprehensive
information about college expenses.
Helps students and families
successfully navigate financial aid
and scholarship processes enabling
them to plan and prepare for
postsecondary educational
expenses. Provide coaching,
consultation and direct services as
appropriate.
Regularly provides students and
families with comprehensive
information about college
expenses. Helps students and
families successfully navigate
financial aid and scholarship
processes enabling them to plan
and prepare for postsecondary
educational expenses. Provide
coaching, consultation and direct
services as appropriate.
Provides students and families with
comprehensive information about
college expenses. Helps students
and families successfully navigate
financial aid and scholarship
processes enabling them to plan
and prepare for postsecondary
educational expenses. Provide
coaching, consultation and direct
services as appropriate.
□
□
□
□
EVIDENCE:
55
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 2 FOR STUDENT ADVISORS: SUPPORT SERVICES (THE ENVIRONMENT)
COMPONENT
2a:
Support the 504 referral,
evaluation, and accommodation
processes for students in one’s
caseload
INEFFECTIVE
Does not support the 504 referral,
evaluation, and accommodation
processes for students in one’s
caseload.
□
DEVELOPING
EFFECTIVE
Rarely supports the 504 referral,
evaluation, and accommodation
processes for students in one’s
caseload.
□
Regularly supports the 504
referral, evaluation, and
accommodation processes for
students in one’s caseload.
□
HIGHLY EFFECTIVE
Continually supports the 504 referral,
evaluation, and accommodation
processes for students in one’s
caseload.
□
EVIDENCE:
2b:
Assist students in crisis
situations, and refer to district or
community resources when
appropriate
Does not assist students in crisis
situations, and refer to district or
community resources when
appropriate.
Occasionally assists students in
crisis situations, and refer to district
or community resources when
appropriate.
Routinely assists students in
crisis situations, and refer to
district or community resources
when appropriate.
Consistently assists students in crisis
situations, and refer to district or
community resources when
appropriate.
□
□
□
□
Routines for the student advisement
center or classroom work are
nonexistent or in disarray.
Rudimentary and partially successful
routines for the student advisement
center or classroom.
Routines for the student
advisement center or classroom
work effectively.
Routines for the student advisement
center or classroom are seamless.
□
□
EVIDENCE:
2c:
Manage routines
and procedures
□
□
EVIDENCE:
56
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
2d:
Establish standards of conduct
and contribute to the culture for
student behavior throughout the
school
Establishes no standards of conduct
for students during student
advisement sessions and makes no
contribution to maintaining an
environment of civility in the school.
□
Efforts to establish standards of
conduct for student advisement
sessions are partially successful.
Student Advisor attempts, with
limited success, to contribute to the
level of civility in the school as a
whole.
□
Establishes clear standards of
conduct for student advisement
sessions and makes a significant
contribution to the environment of
civility in the school.
Establishes clear standards of
conduct for student advisement
sessions and takes a leadership role
in maintaining the environment of
civility in the school.
□
□
EVIDENCE:
2e:
Organize physical space
The physical environment is in
disarray or is inappropriate to the
planned activities.
□
Attempts to create an inviting and
well-organized physical environment
are partially successful.
□
Advisement center or classroom
arrangements are inviting and
conducive to the planned
activities.
□
Advisement center or classroom
arrangements are consistently
inviting and conducive to the planned
activities
□
EVIDENCE:
57
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 3 FOR STUDENT ADVISORS: SYSTEM SUPPORT (DELIVERY OF SERVICE)
COMPONENT
3a:
Contribute to school wide efforts
such as large-scale assessment
administration
INEFFECTIVE
Does not contribute to school wide
efforts such as large-scale
assessment administration.
□
DEVELOPING
EFFECTIVE
Infrequently contributes to school
wide efforts such as large-scale
assessment administration.
□
Actively contributes to school
wide efforts such as large-scale
assessment administration.
□
HIGHLY EFFECTIVE
Consistently contributes to school
wide efforts such as large-scale
assessment administration.
□
EVIDENCE:
3b:
Contribute to and support school
improvement efforts
Does not contribute to and support
school improvement efforts.
□
Rarely contributes to and supports
school improvement efforts.
Regularly contributes to and
supports school improvement
efforts.
□
□
Consistently contributes to and
supports school improvement efforts.
□
EVIDENCE:
3c:
Demonstrate flexibility and
responsiveness
Adheres to the plan or program, in
spite of evidence of its inadequacy.
□
Makes modest changes in the
student advisement program when
confronted with evidence of the need
for change.
□
Makes revisions in the student
advisement program when they
are needed.
□
Continually seeks ways to improve
the student advisement program
based on data and makes changes
as needed in response to student,
parent, administrator or teacher
input.
□
EVIDENCE:
58
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
3d:
Assess student needs
Does not assess student needs, or
the assessments result in inaccurate
conclusions.
□
Assessments of student needs are
perfunctory.
□
Assesses student needs through
data collection, and understands
the range of student needs in the
school.
□
Conducts detailed and individualized
assessments of student needs to
contribute to program planning.
□
EVIDENCE:
3e:
Other duties as assigned by
school administrators
Does not perform other duties as
assigned by school administrators.
□
Occasionally performs other duties
as assigned by school
administrators.
□
Routinely performs other duties
as assigned by school
administrators.
□
Continually performs other duties as
assigned by school administrators.
□
EVIDENCE:
59
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 4 FOR STUDENT ADVISORS: PROFESSIONAL KNOWLEDGE (PROFESSIONAL RESPONSIBILITIES)
COMPONENT
4a:
Adhere to current federal laws,
state statutes and district policies
related to guidance functions,
including, but not limited to, the
Family Educational Rights and
Privacy Act, child abuse reporting
and graduation requirements
INEFFECTIVE
Does not adhere to current federal
laws, state statutes and district
policies related to guidance
functions, including, but not limited
to, the Family Educational Rights
and Privacy Act, child abuse
reporting and graduation
requirements.
□
DEVELOPING
EFFECTIVE
Infrequently adheres to current
federal laws, state statutes and
district policies related to guidance
functions, including, but not limited
to, the Family Educational Rights
and Privacy Act, child abuse
reporting and graduation
requirements.
Adheres to current federal laws,
state statutes and district policies
related to guidance functions,
including, but not limited to, the
Family Educational Rights and
Privacy Act, child abuse reporting
and graduation requirements.
□
□
HIGHLY EFFECTIVE
Actively adheres to current federal
laws, state statutes and district
policies related to guidance
functions, including, but not limited
to, the Family Educational Rights
and Privacy Act, child abuse
reporting and graduation
requirements.
□
EVIDENCE:
4b:
Remain current with
postsecondary career and college
opportunities
Does not remain current with
postsecondary career and college
opportunities.
□
Rarely remains current with
postsecondary career and college
opportunities.
□
Remains current with
postsecondary career and college
opportunities.
□
Actively remains current with
postsecondary career and college
opportunities.
□
EVIDENCE:
4c:
Remain current with changes in
college admission and financial
aid criteria
Does not remain current with
changes in college admission and
financial aid criteria.
□
Seldom remains current with
changes in college admission and
financial aid criteria.
□
Remains current with changes in
college admission and financial
aid criteria.
□
Actively remains current with
changes in college admission and
financial aid criteria.
□
EVIDENCE:
60
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
4d:
Participate in a professional
community
Relationships with colleagues are
negative or self-serving, and avoids
being involved in school and district
events and projects.
□
Relationships with colleagues are
cordial, and participates in school
and district events and projects when
specifically requested.
Participates actively in school and
district events and projects and
maintains positive and productive
relationships with colleagues.
□
□
Makes a substantial contribution to
school and district events and
projects and assumes leadership
with colleagues.
□
EVIDENCE:
4e:
Engage in professional
development
Does not participate in professional
development activities even when
such activities are clearly needed for
the development of student
advisement skills.
□
Participation in professional
development activities is limited to
those that are convenient or are
required.
□
Seeks out opportunities for
professional development based
on an individual assessment of
need.
□
Actively pursues professional
development opportunities and
makes a substantial contribution to
the campus by sharing relevant
information with faculty and staff.
□
EVIDENCE:
4f:
Display professionalism
Displays unprofessionalism in
interactions with colleagues,
students, and the public; violates
principles of confidentiality.
□
Sporadically displays professional
interactions with colleagues,
students, and the public; and
recognizes the need for
confidentiality.
□
Displays honesty, integrity, and
confidentiality in interactions with
colleagues, students, and the
public; advocates for students
when needed.
□
Can be counted on to hold the
highest standards of honesty,
integrity, and confidentiality and to
advocate for students, taking a
leadership role with colleagues.
□
EVIDENCE:
61
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
K-8 Counselor Performance Evaluation (Form 1F)
Employee:
School Year:
School:
EIN:
Fall Summative Evaluation
Evaluator:
Status:
Probationary
Date:
□
□
Spring Summative Evaluation
Continuing
□
Evaluation
□
□
Self-Review
□
DOMAIN 1 FOR K-8 COUNSELORS: PLANNING AND PREPARATION
COMPONENT
1a:
Demonstrating knowledge
of counseling theory and
techniques
INEFFECTIVE
Counselor demonstrates little
understanding of Counseling theory
and techniques.
□
DEVELOPING
EFFECTIVE
Counselor demonstrates basic
understanding of Counseling theory
and techniques.
□
Counselor demonstrates
understanding of counseling
theory and techniques.
□
HIGHLY EFFECTIVE
Counselor demonstrates deep and
thorough understanding of
counseling theory and techniques.
□
EVIDENCE:
1b:
Demonstrating knowledge
of required Educational Career
Action Plan (ECAP)
Counselor demonstrates little or no
knowledge of Educational Career
Action Plan (ECAP).
□
Counselor demonstrates basic
awareness of Educational Career
Action Plan (ECAP).
□
Counselor demonstrates a
complete understanding of
Educational Career Action Plan
(ECAP).
□
Counselor demonstrates a complete
and comprehensive understanding of
Educational Career Action Plan
(ECAP).
□
EVIDENCE:
62
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1c:
Establishing goals for the
counseling program appropriate
to the setting
and the students served
Counselor has no clear goals for the
counseling program, or they are
inappropriate to either the situation
or the age of the students.
Counselor’s goals for the counseling
program are rudimentary and are
partially suitable to the situation and
the age of the students.
Counselor’s goals for the
counseling program are clear and
appropriate to the situation in the
school and to the age of the
students.
Counselor’s goals for the student
counseling program are highly
appropriate to the situation in the
school and to the age of the students
and have been developed following
consultations with students, parents,
and colleagues.
□
□
□
□
Counselor displays awareness of
governmental regulations and of
resources for students available
through the school or district, but no
knowledge of resources available
more broadly.
Counselor displays awareness of
governmental regulations and of
resources for students available
through the school or district, and
some familiarity with resources
external to the school.
Counselor’s knowledge of
governmental regulations and of
resources for students is extensive,
including those available through the
school or district and in the
community.
□
□
□
EVIDENCE:
1d:
Demonstrating knowledge of state
and federal regulations and of
resources both within and beyond
the school and district
Counselor demonstrates little or no
knowledge of governmental
regulations and of resources for
students available through the
school or district.
□
EVIDENCE:
1e:
Planning the counseling program,
integrated with the regular school
program
Counseling program consists of a
random collection of unrelated
activities, lacking coherence or an
overall structure.
□
Counselor’s plan has a guiding
principle and includes a number of
worthwhile activities, but some of
them don’t fit with the broader goals.
□
Counselor has developed a plan
that includes the important
aspects of Counseling in the
setting.
□
Counselor’s plan is highly coherent
and serves to support not only the
students individually and in groups,
but also the broader educational
program.
□
EVIDENCE:
63
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
1f:
Developing a plan to evaluate the
counseling program
Counselor has no plan to evaluate
the program or resists suggestions
that such an evaluation is important.
Counselor has a rudimentary plan to
evaluate the Counseling program.
Counselor’s plan to evaluate the
program is organized around clear
goals and the collection of
evidence to indicate the degree to
which the goals have been met.
Counselor’s evaluation plan is highly
sophisticated, with imaginative
sources of evidence and a clear path
toward improving the program on an
ongoing basis.
□
□
□
□
EVIDENCE:
64
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 2 FOR K-8 COUNSELORS: THE ENVIRONMENT
COMPONENT
2a:
Creating an environment of
respect and rapport
INEFFECTIVE
Counselor’s interactions with
students are negative or
inappropriate, and the Counselor
does not promote positive
interactions among students.
□
DEVELOPING
EFFECTIVE
Counselor’s interactions are a mix of
positive and negative; the
Counselor’s efforts at encouraging
positive interactions among students
are partially successful.
□
Counselor’s interactions with
students are positive and
respectful, and the Counselor
actively promotes positive
student-student interactions.
□
HIGHLY EFFECTIVE
Students seek out the Counselor,
reflecting a high degree of comfort
and trust in the relationship.
Counselor teaches students how
to engage in positive interactions.
□
EVIDENCE:
2b:
Establishing a culture for
productive communication
Counselor makes no attempt to
establish a culture for productive
communication in the school as a
whole, either among students or
among teachers, or between
students and teachers.
□
Counselor’s attempts to promote a
culture throughout the school for
productive and respectful
communication between and among
students and teachers are partially
successful.
□
Counselor promotes a culture
throughout the school for
productive and respectful
communication between and
among students and teachers.
□
The culture in the school for
productive and respectful
communication between and among
students and teachers, while guided
by the Counselor, is maintained by
both teachers and students.
□
EVIDENCE:
2c:
Managing routines
and procedures
Counselor’s routines for the
Counseling center or classroom work
are nonexistent or in disarray.
□
Counselor has rudimentary and
partially successful routines for the
Counseling center or classroom.
□
Counselor’s routines for the
Counseling center or classroom
work effectively.
□
Counselor’s routines for the
Counseling center or classroom are
seamless, and students assist in
maintaining them.
□
EVIDENCE:
65
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
2d:
Establishing standards of conduct
and contributing to the culture for
student behavior throughout the
school
Counselor has established no
standards of conduct for students
during counseling sessions and
makes no contribution to maintaining
an environment of civility in
the school.
Counselor’s efforts to establish
standards of conduct for counseling
sessions are partially successful.
Counselor attempts, with limited
success, to contribute to the level of
civility in the school as a whole.
Counselor has established clear
standards of conduct for
counseling sessions and makes a
significant contribution to the
environment of civility in the
school.
Counselor has established clear
standards of conduct for counseling
sessions, and students contribute to
maintaining them. Counselor takes a
leadership role in maintaining the
environment of civility in the school.
□
□
□
□
EVIDENCE:
2e:
Organizing physical space
The physical environment is in
disarray or is inappropriate to the
planned activities.
□
Counselor’s attempts to create an
inviting and well-organized physical
environment are partially successful.
□
Counseling center or classroom
arrangements are inviting and
conducive to the planned
activities.
□
Counseling center or classroom
arrangements are inviting and
conducive to the planned activities.
Students have contributed ideas to
the physical arrangement.
□
EVIDENCE:
66
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 3 FOR K-8 COUNSELORS: DELIVERY OF SERVICE
COMPONENT
3a:
Assessing student needs
INEFFECTIVE
Counselor does not assess student
needs, or the assessments result in
inaccurate conclusions.
DEVELOPING
EFFECTIVE
Counselor’s assessments of student
needs are perfunctory.
□
□
Counselor’s program is independent
of identified student needs.
Counselor’s attempts to help
students and teachers formulate
academic, personal/social, and
career plans are partially successful.
□
□
Counselor assesses student
needs and knows the range of
student needs in the school.
□
HIGHLY EFFECTIVE
Counselor conducts detailed and
individualized assessments of
student needs to contribute to
program planning.
□
EVIDENCE:
3b:
Assisting students and teachers
in the formulation of academic,
personal/social, and career plans,
based on knowledge of student
needs
Counselor helps students and
teachers formulate academic,
personal/social, and career plans
for groups of students.
□
Counselor helps individual students
and teachers formulate academic,
personal/social, and career plans.
□
EVIDENCE:
3c:
Use of instructional strategies in
classroom lessons
Counselor is not using effective
instructional strategies in classroom
instruction.
□
Counselor inconsistently uses
effective instructional strategies in
classroom instruction.
□
Counselor consistently uses a
variety of effective instructional
strategies in classroom
instruction.
□
Counselor uses a variety of highly
effective instructional strategies in
classroom instruction.
□
EVIDENCE:
67
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
3d:
College and career readiness
framwork
Counselor shows no evidence of
College and Career readiness
Framework implementation in
assigned grades.
□
Counselor shows inconsistent
implementation of College and
Career readiness Framework in
assigned grades.
Counselor provides consistent
implementation of College and
Career readiness Framework in
assigned grades.
□
□
Counselor makes modest changes in
the Counseling program when
confronted with evidence of the need
for change.
Counselor makes revisions in the
Counseling program when they
are needed.
□
□
Counselor demonstrates exceptional
and comprehensive implementation
of College and Career Readiness
Framework in assigned grades.
□
EVIDENCE:
3e:
Demonstrating flexibility and
responsiveness
Counselor adheres to the plan or
program, in spite of evidence of its
inadequacy.
□
Counselor is continually seeking
ways to improve the Counseling
program and makes changes as
needed in response to student,
parent, or teacher input.
□
EVIDENCE:
68
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
DOMAIN 4 FOR K-8 COUNSELORS: PROFESSIONAL RESPONSIBILITIES
COMPONENT
4a:
Reflecting on practice
INEFFECTIVE
Counselor does not reflect on
practice, or the reflections are
inaccurate or self-serving.
□
DEVELOPING
EFFECTIVE
HIGHLY EFFECTIVE
Counselor’s reflection on practice is
moderately accurate and objective
without citing specific examples and
with only global suggestions as to
how it might be improved.
Counselor’s reflection provides an
accurate and objective description
of practice, citing specific positive
and negative characteristics.
Counselor makes some specific
suggestions as to how the
Counseling program might be
improved.
Counselor’s reflection is highly
accurate and perceptive, citing
specific examples that were not fully
successful for at least some
students. Counselor draws on an
extensive repertoire to suggest
alternative strategies.
□
□
□
EVIDENCE:
4b:
Maintaining records and
submitting them in a timely
fashion
Counselor’s reports, records, and
documentation are missing, late, or
inaccurate, resulting in confusion.
Counselor’s reports, records, and
documentation are generally
accurate but are occasionally late.
Counselor’s reports, records, and
documentation are accurate and
are submitted in a timely manner.
Counselor’s approach to record
keeping is highly systematic and
efficient and serves as a model for
colleagues in other schools.
□
□
□
□
Counselor provides no information to
families, either about the Counseling
program as a whole or about
individual students.
Counselor provides limited though
accurate information to families
about the Counseling program as a
whole and about individual students.
Counselor provides thorough and
accurate information to families
about the Counseling program as
a whole and about individual
students.
Counselor is proactive in providing
information to families about the
Counseling program and about
individual students through a variety
of means.
□
□
□
□
EVIDENCE:
4c:
Communicating with families
EVIDENCE:
69
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
4d:
Participating in a professional
community
Counselor’s relationships with
colleagues are negative or selfserving, and Counselor avoids being
involved in school and district events
and projects.
Counselor’s relationships with
colleagues are cordial, and
Counselor participates in school and
district events and projects when
specifically requested.
Counselor participates actively in
school and district events and
projects and maintains positive
and productive relationships with
colleagues.
□
□
□
Counselor makes a substantial
contribution to school and district
events and projects and assumes
leadership with colleagues.
□
EVIDENCE:
4e:
Engaging in professional
development
Counselor does not participate in
professional development activities
even when such activities are clearly
needed for the development of
Counseling skills.
□
Counselor’s participation in
professional development activities
is limited to those that are
convenient or are required.
□
Counselor seeks out
opportunities for professional
development based on an
individual assessment of need.
Counselor actively pursues
professional development
opportunities and makes a
substantial contribution to the
profession through such activities as
offering workshops to colleagues.
□
□
Counselor displays high
standards of honesty, integrity,
and confidentiality in interactions
with colleagues, students, and the
public; advocates for students
when needed.
Counselor can be counted on to hold
the highest standards of honesty,
integrity, and confidentiality and to
advocate for students, taking a
leadership role with colleagues.
□
□
EVIDENCE:
4f:
Showing professionalism
Counselor displays dishonesty in
interactions with colleagues,
students, and the public; violates
principles of confidentiality.
□
Counselor is honest in interactions
with colleagues, students, and the
public; does not violate
confidentiality.
□
EVIDENCE:
70
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
Nurse Performance Profile and Rating (Form 2A)
Domain 1: Planning and Preparation
1a: Demonstrating knowledge of school nurse practice by maintaining student
health and safety on campus/Understanding the professional, ethical and legal
standards that guide the nurse in the school setting
1b: Demonstrating knowledge of child and adolescent development
1c: Establishing goals for the school health program appropriate to the setting and
the students served
1d: Demonstrating knowledge of nursing scope of practice/Utilizes district
resources and health manual procedures/Follows state and federal regulations, by
maintaining appropriate license and certifications
1e: Writing Individual Healthcare Plans for Students.
1f: Demonstrating knowledge of school and community resources
Domain 2: The Environment
2a: Creating an environment of respect and rapport in professional relationships
and with students, staff and parents
2b: Establishing an environment that is culturally sensitive
2c: Utilizing health protocols and procedures in providing care to students
2d: Supervising Health Assistants
2e: Organizing health office
Domain 3: Delivery of Service
3a: Assessing student needs
3b: Administering medications to students
3c: Promoting wellness through individual, classroom or school wide education,
Acts as a public health resource
3d: Managing emergency situations
3e: Collaborating with parent and teachers to develop Individualized Healthcare
Plans (IHP) and services for students with special medical needs
71
Highly
Effective
Effective
Developing
□
Final Summative
Due No Later Than March 31
Ineffective
Continuing
Highly
effective
□
Effective
Probationary
Developing
Status:
Date: __________
Ineffective
Evaluator:
Date: __________
Highly
Effective
School Year:
Spring Summative
Observation Experience #2
Effective
School/Department:
Fall Summative
Observation Experience #1
Developing
EIN:
Ineffective
Employee:
Domain 4: Professional Responsibilities
4a: Reflecting on Nursing Practice which is based on current scientific evidence
4b: Maintaining health records in accordance with policy and submitting reports in a timely
fashion
4c: Professional communication
4d: Maintaining confidentiality
4e: Engaging in professional development
4f: Shows professionalism by being a good role model including dependable attendance,
punctuality in performance of duties and professional appearance
Final Summative Specialist Performance Rating
Ineffective (0)
□
3 or more Ineffective ratings
Developing (1)
□
1 or 2 Ineffective ratings
or
4 or more Developing ratings
Effective (2)
□
Zero Ineffective ratings and fewer
than 4 Developing ratings
Highly Effective (3)
At least 7 Highly Effective ratings
and
Zero Ineffective and Developing ratings
Final Specialist Evaluation Rating
Evaluator’s Printed Name
Specialist’s Printed Name
Fall Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
Final Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
72
□
Psychologist Performance Profile and Rating (Form 2B)
Domain 1: Planning and Preparation
1a: Demonstrating knowledge of the profession of psychology, including
professional, ethical, and legal standards and regulations that guide the practice of
psychology in education
1b: Demonstrating knowledge
of child and adolescent characteristics, including knowledge of development,
cultural diversity, and psychopathology
1c: Demonstrating knowledge of assessment, including selecting and using a range
of psychological instruments to evaluate students, linked to assessment concerns
and potential interventions
1d: Demonstrating knowledge of procedures and resources, including district
procedures, state and federal regulations, resources within and beyond the school
and district, and the continuum of services available to students
1e: Designing a cohesive service delivery system that solves school-wide
problems, meets the needs of individual students, and includes prevention
1f: Demonstrating knowledge of research-based instructional, behavioral, and
mental health interventions
Domain 2: The Environment
2a: Maintaining an environment of respect and rapport in professional relationships and
with students
2b: Supporting a culture of learning and achievement in classrooms, by promoting databased decision-making and research-based interventions
2c: Implementing clear procedures for referrals and for working with the building-level
child study process
2d: Establishing procedures for analyzing student behavior and providing positive
behavioral supports
2e: Organizing physical space, including appropriate testing space, space to consult with
teachers and parents, and maintaining confidential storage for test materials and files
73
Highly
Effective
Effective
Developing
□
Final Summative
Due No Later Than March 31
Ineffective
Continuing
Highly
effective
□
Effective
Probationary
Developing
Status:
Date: __________
Ineffective
Evaluator:
Date: __________
Highly
Effective
School Year:
Spring Summative
Observation Experience #2
Effective
School/Department:
Fall Summative
Observation Experience #1
Developing
EIN:
Ineffective
Employee:
Domain 3: Delivery of Service
3a: Communicating effectively by responding in a timely manner to referrals,
parent requests, and re-evaluation schedules; consulting regularly with teachers
and administrators
3b: Gathering information systematically from multiple sources, using test
instruments appropriately, and considering the context for assessment and
intervention
3c: Serving as case manager of the evaluation team, maintaining contact with
other professionals throughout the assessment process, and writing integrated
MET reports
3d: Addressing social-emotional needs of students by providing social skills
training, counseling, and/or behavioral coaching, and working with teachers
and/or parents to plan and implement interventions
3e: Demonstrating flexibility and responsiveness
Domain 4: Professional Responsibilities
4a: Reflecting on practice
4b: Maintaining accurate records
4c: Communicating with families
4d: Participating in professional communities, including those established at
assigned schools and with school psychologist colleagues
4e: Growing and developing professionally
4f: Demonstrating professionalism
74
Final Summative Specialist Performance Rating
Ineffective (0)
□
3 or more Ineffective ratings
Developing (1)
□
1 or 2 Ineffective ratings
or
4 or more Developing ratings
Effective (2)
□
Zero Ineffective ratings and fewer
than 4 Developing ratings
Highly Effective (3)
At least 7 Highly Effective ratings
and
Zero Ineffective and Developing ratings
Final Specialist Evaluation Rating
Evaluator’s Printed Name
Specialist’s Printed Name
Fall Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
Final Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
75
□
Instructional Specialist Performance Profile and Rating (Form 2C)
Domain 1: Planning and Preparation
1a: Demonstrating knowledge of current trends in specialty area and professional
development
1b: Demonstrating knowledge of the school’s program and levels of teacher skill
in delivering that program
1c: Establishing goals for the instructional support program appropriate to the
setting and the teachers served
1d: Demonstrating knowledge of resources, both within and beyond the school
and district
1e: Planning the instructional support program, integrated with the overall school
program
1f: Developing a plan to evaluate the instructional support program
Domain 2: The Environment
2a: Creating an environment of trust and respect
2b: Establishing a culture for ongoing instructional improvement
2c: Establishing clear procedures for teachers to gain access to instructional
support
2d: Establishing and maintaining norms of behavior for professional interactions
2e: Organizing physical space for workshops or training
Domain 3: Delivery of Service
3a: Collaborating with teachers in the design of instructional units and lessons
3b: Engaging teachers in learning new instructional skills
3c: Sharing expertise with staff
3d: Locating resources for teachers to support instructional improvement
3e: Demonstrating flexibility and responsiveness
76
Highly
Effective
Effective
Developing
□
Final Summative
Due No Later Than March 31
Ineffective
Continuing
Highly
effective
□
Effective
Probationary
Developing
Status:
Date: __________
Ineffective
Evaluator:
Date: __________
Highly
Effective
School Year:
Spring Summative
Observation Experience #2
Effective
School/Department:
Fall Summative
Observation Experience #1
Developing
EIN:
Ineffective
Employee:
Domain 4: Professional Responsibilities
4a: Reflecting on practice
4b: Preparing and submitting budgets and reports
4c: Coordinating work with other instructional specialists
4d: Participating in a professional community
4e: Engaging in professional development
4f: Showing professionalism, including integrity and confidentiality
Final Summative Specialist Performance Rating
Ineffective (0)
□
3 or more Ineffective ratings
Developing (1)
□
1 or 2 Ineffective ratings
or
4 or more Developing ratings
Effective (2)
□
Zero Ineffective ratings and fewer
than 4 Developing ratings
Highly Effective (3)
At least 7 Highly Effective ratings
and
Zero Ineffective and Developing ratings
Final Specialist Evaluation Rating
Evaluator’s Printed Name
Specialist’s Printed Name
Fall Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
Final Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
77
□
Therapeutic Specialist Performance Profile and Rating (Form 2D)
Domain 1: Planning and Preparation
1a: Demonstrating knowledge and skill in the specialist therapy area; holding the
relevant certificate or license
1b: Establishing goals for the therapy program appropriate to the setting and the
students served
1c: Demonstrating knowledge of district, state, and federal regulations and
guidelines
1d: Demonstrating knowledge of resources, both within and beyond the school
and district
1e: Planning the therapy program, integrated with the regular school program, to
meet the needs of individual students
1f: Developing a plan to evaluate the therapy program
Domain 2: The Environment
2a: Establishing rapport with students
2b: Organizing time effectively
2c: Establishing and maintaining clear procedures for referrals
2d: Establishing standards of conduct in the treatment center
2e: Organizing physical space for testing of students and providing therapy
Domain 3: Delivery of Service
3a: Responding to referrals and evaluating student needs
3b: Developing and implementing treatment plans to maximize students’ success
3c: Communicating with families
3d: Collecting information; writing reports
3e: Demonstrating flexibility and responsiveness
78
Highly
Effective
Effective
Developing
□
Final Summative
Due No Later Than March 31
Ineffective
Continuing
Highly
effective
□
Effective
Probationary
Developing
Status:
Date: __________
Ineffective
Evaluator:
Date: __________
Highly
Effective
School Year:
Spring Summative
Observation Experience #2
Effective
School/Department:
Fall Summative
Observation Experience #1
Developing
EIN:
Ineffective
Employee:
Domain 4: Professional Responsibilities
4a: Reflecting on practice
4b: Collaborating with teachers and administrators
4c: Maintaining an effective data-management system
4d: Participating in a professional community
4e: Engaging in professional development
4f: Showing professionalism, including integrity, advocacy, and maintaining
confidentiality
Final Summative Specialist Performance Rating
Ineffective (0)
□
3 or more Ineffective ratings
Developing (1)
□
1 or 2 Ineffective ratings
or
4 or more Developing ratings
Effective (2)
□
Zero Ineffective ratings and fewer
than 4 Developing ratings
Highly Effective (3)
At least 7 Highly Effective ratings
and
Zero Ineffective and Developing ratings
Final Specialist Evaluation Rating
Evaluator’s Printed Name
Specialist’s Printed Name
Fall Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
Final Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
79
□
Student Advisor Performance Profile and Rating (Form 2E)
Domain 1: Graduation/College & Career Readiness (Planning and Preparation)
1a: Develop and implement strategies to facilitate successful transition from
eighth grade to high school
1b: Monitor students’ academic progress and provide personalized guidance,
including transcript evaluation, and support to those who are not on track to
graduate within in four years. Develop and implement student-specific and
system-level strategies that increase the schools’ rate of graduation and
postsecondary enrollment.
1c: Develop and implement intervention strategies for students who demonstrate
absentee, behavioral or academic need
1d: Ensure that each student develops an ECAP specific to their interests, talents
and aspirations. Modify student’s schedules and courses of study when
appropriate.
1e: Provide ongoing exposure to the information and experiences necessary to
make informed decisions when selecting a postsecondary program or career
1f: Assist students in establishing postsecondary goals and successfully
completing a high school course of study that prepares them to meet those goals
1g: Promote preparation for and participation in college and career assessments
such as the PSAT/NMSQT, SAT, ACT, ASVAB and ACCUPLACER. Facilitate
students’ understanding of results and how this information can be applied to
course selection and skill development.
1h: Provide students and families with comprehensive information about college
expenses. Help students and families successfully navigate financial aid and
scholarship processes enabling them to plan and prepare for postsecondary
educational experiences. Provide coaching, consultation and direct services as
appropriate.
80
Highly
Effective
Effective
Developing
□
Final Summative
Due No Later Than March 31
Ineffective
Continuing
Highly
effective
□
Effective
Probationary
Developing
Status:
Date:
Ineffective
Evaluator:
Date:
Highly
Effective
School Year:
Spring Summative
Observation Experience #2
Effective
School/Department:
Fall Summative
Observation Experience #1
Developing
EIN:
Ineffective
Employee:
Domain 2: Support Services (The Environment)
2a: Support the 504 referral, evaluation and accommodation processes for students
in one’s caseload
2b: Assist students in crisis situations and refer to district or community resources
when appropriate
2c: Managing routines and procedures
2d: Establish standards of conduct and contribute to the culture for student
behavior throughout the school
2e: Organize physical space
Domain 3: System Support (Delivery of Service)
3a: Contribute to school wide efforts such as large-scale assessment administration
3b: Contribute to and support school improvement plans
3c: Demonstrate flexibility and responsiveness
3d: Assess student needs
3e: Other duties as assigned by school administrator
Domain 4: Professional Knowledge (Professional Responsibilities)
4a: Adhere to current with federal laws, state statutes and district policies related
to guidance functions, including but not limited to, the Family Educational Rights
and Privacy Act, child abuse reporting and graduation requirements
4b: Remain current with postsecondary college and career opportunities
4c: Remain current with changes in college admission and financial aid criteria
4d: Participating in a professional community
4e: Engage in professional development
4f: Display professionalism
81
Final Summative Specialist Performance Rating
Ineffective (0)
□
3 or more Ineffective ratings
Developing (1)
□
1 or 2 Ineffective ratings
or
4 or more Developing ratings
Effective (2)
□
Zero Ineffective ratings and fewer
than 4 Developing ratings
Highly Effective (3)
At least 7 Highly Effective ratings
and
Zero Ineffective and Developing ratings
Final Specialist Evaluation Rating
Evaluator’s Printed Name
Student Advisor’s Printed Name
Fall Summative
Evaluator’s Signature
Student Advisor’s Signature
Date
Date
Spring and Final Summative
Evaluator’s Signature
Student Advisor’s Signature
Date
Date
82
□
K-8 Counselor Performance Profile and Rating (Form 2F)
Domain 1: Planning and Preparation
1a: Demonstrating knowledge of counseling theory and techniques
1b: Demonstrating knowledge of required Educational Career Action Plan (ECAP)
1c: Establishing goals for the counseling program appropriate to the setting and
the students served
1d: Demonstrating knowledge of state and federal regulations and of resources
both within and beyond the school and district
1e: Planning the counseling program, integrated with the regular school program
1f: Developing a plan to evaluate the student advisement program
Domain 2: The Environment
2a: Creating an environment of respect and rapport
2b: Establishing a culture for productive communication
2c: Managing routines and procedures
2d: Establishing standards of conduct and contributing to the culture for student
behavior throughout the school
2e: Organizing physical space
Domain 3: Delivery of Services
3a: Assessing student needs
3b: Assisting students and teachers in the formulation of academic,
personal/social, and career plans, based on knowledge of student needs
3c: Use of instructional strategies in classroom lessons
3d: College and career readiness framework
3e: Demonstrating flexibility and responsiveness
83
Highly
Effective
Effective
Developing
□
Final Summative
Due No Later Than March 31
Ineffective
Continuing
Highly
effective
□
Effective
Probationary
Developing
Status:
Date:
Ineffective
Evaluator:
Date:
Highly
Effective
School Year:
Spring Summative
Observation Experience #2
Effective
School/Department:
Fall Summative
Observation Experience #1
Developing
EIN:
Ineffective
Employee:
Domain 4: Professional Responsibilities
4a: Reflecting on practice
4b: Maintaining records and submitting them in a timely fashion
4c: Communicating with families
4d: Participating in a professional community
4e: Engaging in professional development
4f: Showing professionalism
Final Summative Specialist Performance Rating
Ineffective (0)
□
3 or more Ineffective ratings
Developing (1)
□
1 or 2 Ineffective ratings
or
4 or more Developing ratings
Effective (2)
□
Zero Ineffective ratings and fewer
than 4 Developing ratings
Highly Effective (3)
At least 7 Highly Effective ratings
and
Zero Ineffective and Developing ratings
Final Specialist Evaluation Rating
Evaluator’s Printed Name
Specialist’s Printed Name
Fall Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
Spring and Final Summative
Evaluator’s Signature
Specialist’s Signature
Date
Date
84
□
Professional Refinement Plan (Form 3)
Employee:
School Year:
School/Department:
Evaluator:
Status:
Probationary
Specialist
Classification:
Nurse
□
□
Continuing
Psychologist
□
EIN:
□
□
Instructional
Specialist
Therapeutic
Specialist
□
Area for Refinement
Plan
Evaluator’s Signature
Specialist’s Signature
Date
Date
Summary of Work Completed
Evaluator’s Signature
Specialist’s Signature
Date
Date
85
Student
Advisor
□
□
K-8
Counselor
Professional Remediation Plan (Form 4)
Employee:
School Year:
School/Department:
Evaluator:
Status:
Probationary
Specialist
Classification:
Nurse
□
□
Continuing
Psychologist
□
EIN:
□
□
Instructional
Specialist
Therapeutic
Specialist
□
Plan
Goal:
Strategy 1:
Action Steps:
Strategy 2:
Action Steps:
Strategy 3:
Action Steps:
Evaluator’s Signature
Specialist’s Signature
Date
Date
Results
□
□
Progress on goal
Limited or no progress on goal
Comments:
Evaluator’s Signature
Specialist’s Signature
Date
Date
86
Student
Advisor
□
□
K-8
Counselor
Notification of Inadequate Specialist Performance-Fall (Form 5)
Employee:
School Year:
School/Department:
Evaluator:
Status:
Probationary
Specialist
Classification:
Nurse
□
□
Continuing
Psychologist
□
EIN:
□
Instructional
Specialist
□
Therapeutic
Specialist
□
Student
Advisor
□
□
K-8
Counselor
The specialist listed above has been rated “Ineffective” on the Fall Summative Specialist
Performance Evaluation or is a continuing status specialist who has been rated “Ineffective” or
“Developing” on last year’s Final Summative Specialist Performance Evaluation and this year’s
Fall Summative Specialist Performance Evaluation. A signed copy of the specialist’s Specialist
Performance Profile and Rating (Form 2-Specialist Specific) is included with this notification.
Listed below are the “Ineffective” components (and “Developing” components if the specialist is
continuing status and rated “Ineffective” or “Developing” for two consecutive years as described
above):
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Evaluator’s Signature
Specialist’s Signature
Date
Date
87
Notification of Inadequate Specialist Performance-Final (Form 5)
Employee:
School Year:
School/Department:
Evaluator:
Status:
Probationary
Specialist
Classification:
Nurse
□
□
Continuing
Psychologist
□
EIN:
□
Instructional
Specialist
□
Therapeutic
Specialist
□
Student
Advisor
□
□
K-8
Counselor
The specialist listed above has been rated “Ineffective” on the Final Summative Specialist
Performance Evaluation. A signed copy of the specialist’s Specialist Performance Profile and
Rating (Form 2-Specialist Specific) is included with this notification.
The Ineffective components are:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Evaluator’s Signature
Specialist’s Signature
Date
Date
88
Appendix
89
Appendix A-List of Specialists


























Career & Technical Education Specialist
Community Education Specialist
Content/Program Specialist
Counselor (K-8)
Department Specialist
Educational Technology Trainer
Elementary/Secondary Division Specialist
English as a Second Language/Bilingual Specialist
Flight Simulator Teacher
Instructional Intervention Specialist
Math/Reading Coach
Mesa Distance Learning Program Specialist
Music Specialist
Native American Specialist
Preschool Evaluator
Preventive Programs Specialist
Professional Development Specialist
Project Mesa Teacher
School Nurse
School Psychologist
Space Integration Module Teacher
Speech Language Pathologist
Student Advisor
Sub Cadre Teacher
Therapeutic Specialist (OT/PT)
Title 1 Specialist
90
Appendix B-Summary of Domains
The organization of the frameworks for specialists closely follows that of the framework for
teaching. Each has four domains and 22 components. Each domain has the same emphasis as in
the framework for teaching: Planning and Preparation, The Environment, Delivery of Service and
Professional Responsibilities.
Domain 1: Planning and Preparation (Student Advisor-Graduation/College & Career Readiness)
Each specialist framework includes a domain titled Planning and Preparation. Every specialist must
plan and prepare, although some of the details of that planning may differ from that done by a
teacher. However, it is primarily a matter of emphasis. For some specialists, the knowledge of
resources is critical; it is integral to the work of, for example, a school psychologist.
Domain 2: The Environment (Student Advisor-Support Services)
Each specialist framework includes a domain that covers environment. In some cases, the
environment for school nurses may be an office or center that students go to and that should be
inviting. For instructional specialists, who work primarily with other teachers, the environment
may refer to the tone in the room where the workshop is conducted. For those specialists whose
responsibilities include working with students, such as a speech and language specialist or
occupational therapist, the environment is similar to that of a classroom teacher.
Domain 3: Delivery of Service (Student Advisor-System Support)
In the specialist frameworks, Delivery of Service is equivalent to Instruction in the framework for
teaching. All specialists do important work, but not all of it is actual teaching; in some cases it
involves assessing individual student needs or conducting small group or individual counseling
sessions. Specialists in all fields follow the established protocols and best practice of their own
organizations; the components of the framework for teaching do not always apply.
Domain 4: Professional Responsibilities (Student Advisor-Professional Knowledge)
All specialists have obligations in the domain of Professional Responsibilities, and many of these
are virtually identical to those of classroom teachers. They all reflect on their practice and maintain
records. For some, communicating with families is a significant part of their work. Furthermore,
all specialists participate in a professional community, and their collaboration with other teachers is
central to their work.
Copyright ©2008 by the Association for Supervision and Curriculum Development (ASCD)
91
Appendix C-Specialist Performance Classifications
Classification
Highly
Effective
Description
There is evidence of high levels of knowledge, implementation,
and integration of performance standards, along with evidence of
leadership initiative and willingness to model and serve as a
mentor for colleagues. Specialists performing at this level are
masters of their specialist responsibilities and leaders in the
field, both inside and outside their school.
Standard:
7 or more “Highly Effective” ratings and no “Developing” or
“Ineffective” ratings
Effective
There is evidence of increased knowledge, implementation, and
integration of performance standards, and clear proficiency and
skill in the performance area. This rating refers to successful,
professional specialist performance that is consistently at a high
level. It is expected that most experienced specialists frequently
perform at this level.
Standard:
3 or fewer “Developing” ratings and no “Ineffective” ratings
Developing
There is evidence of basic knowledge and implementation of
performance standards. Integration of performance standards is
not evident. This indicates that the specialist has the necessary
knowledge and skills to be effective, but the application of those
skills is inconsistent.
Standard:
4 or more “Developing” ratings or 1 or 2 “Ineffective” ratings
Ineffective
There is little or no knowledge and minimal implementation of
performance standards. The specialist does not meet minimal
performance standards and needs substantial improvement. This
rating refers to specialist performance that does not convey an
understanding of the concepts underlying the component. This
level of performance is hindering learning.
Standard:
3 or more “Ineffective” ratings
92