2015-2016 Teacher Work Sample Template
This is the official Teacher Work Sample Template for 2015-2016. You
must complete this template; it is the only acceptable template for Fall
2015 and Spring 2016. The template requires Microsoft Word, version
2007 or more recent. Save as either a .docx or .pdf file. If using an iPad
device, submit using Pages. If using a laptop or desktop Mac, download
the Microsoft Remote Desktop app and use it to access Word via the
virtual server there. It is a free app for students. Microsoft Office 2013
or 2011 for Mac are available as a free download for currently registered
students. Navigate to the Office for Students page to learn more about
system requirements and download the suite of tools.
Submit the TWS in Canvas following the instructions in your PDS or
Student Teacher Manual.
The template is already set with 1” margins, 12 point font, and page
numbers starting with page 1 for Factor 1. You need to set the double
space.
Consult the TWS Prompt and Rubric in your PDS or Student Teacher
Manual for specific directions. Scorers will follow the rubric to
determine appropriate score values.
Instruction reminders are included in red throughout the document;
delete them as you complete your TWS. Delete all comments in red
before submitting your final TWS to the Associate Dean’s Office.
*Submitting the TWS Cover Page
(Electronic submission through Canvas)
Prior to submitting your TWS online through Canvas, you must submit a
cover page using the link provided in the cover page module in Canvas.
The cover page with electronic signature verifies that the TWS submitted is the
candidates own authentic work. The candidates understand that obtaining, or
attempting to obtain, a passing grade on a TWS by falsification or
misrepresentation may result in a failing grade in a course or expulsion from the
teacher education program. I understand that any misrepresentation of facts may
result in the denial or revocation of my license.
Teacher Verification Signature: Ask your cooperating/mentor teacher to send
an email to Mary Benjamin (mbenjami@emporia.edu) stating: "This is
verification that (insert student/intern’s name) submitting the TWS is a student
teacher/intern at this school and that to the best of my knowledge it is his/her own
work." This email must come from the cooperating/mentor teacher’s school email address.
A Teacher Work Sample will not be scored without proper verifications
from both the candidate and the cooperating/mentor teacher!
You should NOT expect your supervising/ mentor teacher to verify your TWS
without having an opportunity to review it.
Candidates must submit/complete the Cover Page Module to access TWS
submission.
Remember: Completed TWS must be submitted on Canvas (see instructions
on previous pages). TWS MUST be received NO LATER THAN 5:00 p.m.
on the specified due date: Monday, November 16, 2015 for the Fall 2015
semester and Monday, April 18, 2016 for the Spring 2016 semester.
Demographic Information Sheet
(attach to your completed TWS after the Cover Page)
Please indicate:
Semester (Fall or Spring)
Year: 20
Your certification/licensure level (check all that apply):
_____ Early Childhood (Birth – K or Birth – Grade 3)
_____ Secondary (Grades 6 - 12)
_____ Elementary (Grades K - 6)
_____ Dual (Elem. and Secondary, Grades PK - 12)
_____ Middle School (Grades 5 - 8)
Your certification/licensure area(s) (check all that apply):
_____Art
_____ Eng. Lang. Arts, Middle Level
_____Physics
_____Biology
_____French
_____Psychology
_____Business
_____German
_____Science, Middle Level
_____Chemistry
_____History, Middle Level
_____Spanish
_____Early Childhd Uni B-8
_____History and Government
_____Speech and Theatre
_____Early Childhd Uni B-K
_____Journalism
_____Other:_______________
_____Earth-Space Science
_____Mathematics
_____Elementary
_____Mathematics, Middle Level
_____ English Language Arts
_____Music
_____ESOL
_____Physical Education
Identify the course, unit content are, (e.g., “English Language Arts,” “Biology,” “Mathematics,” “History and
Government,” etc.), and grade level(s) of your Teacher Work Sample.
Course
Content Area
The grade(s)/level of students in your classroom (check all that apply):
_____Preschool
_____4th Grade
_____9th Grade
_____Kindergarten
_____5th Grade
_____10th Grade
_____1st Grade
_____6th Grade
_____11th Grade
_____2nd Grade
_____7th Grade
_____12th Grade
_____3rd Grade
_____8th Grade
Factor 1. Contextual Information and Learning Environment Adaptations
12 point font, 1” margins, and page numbers are set. You need to set the double space for all of
your narrative. Use the headings given in the template. Provide background information for
what you will put in the table and give specific numbers. A thoroughly prepared contextual table
will reduce the amount, or completely eliminate, the need for additional narrative, but narrative
must be used if it is needed to provide sufficient information to address the rubric items. A blank
contextual factor table is included below and a sample is included in the TWS Prompt and
Rubric. If there is no implication for instruction for a contextual or environmental factor, be sure
to explain why. The page count starts with the first page of Factor 1 and cannot exceed 25
pages.
A) Explanation of community factors that impact my planning and teaching
B) Explanation of these factors that impact my planning and teaching
1.
District
2.
Classroom physical setting
3.
School population, including socio-economic status (SES) make-up
C) Explanation of these factors that impact my planning and teaching
1.
Classroom’s ethnic/cultural make-up
2.
Classroom’s gender make-up
3.
Classroom students’ with special needs/at-risk students
4.
Classroom students’ developmental characteristics
D) School Improvement Plan and state assessment data.
E) Explanation of community, district, school, classroom, and student factors and implication for
instruction.
Be sure to address all factors that have implications for your instruction.
Optional Contextual Factor Table (add rows as needed)
Contextual and
Environmental Factors
Identify Source of Factor:
Community, District, School,
Classroom, or Student
Implications for Instruction
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Factor 2. Unit Learning Goals and Objectives
Use the headings given in the template.
A) Course, unit content area, and grade level of the Teacher Work Sample:
B) Rationale for choice of unit objectives:
C) Standards that the outcomes are aligned with: Include enough narrative here to show the
relationship between what you are teaching and the standards. Use State Standards or Common
Core Standards unless none exist for your subject area. If no State Standards exist, use Local or
National Standards.
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D) Unit learning goal and outcomes for this instructional sequence. You need at least 1 goal and two objectives for each level.
Add rows to table as needed. List all your low level objectives, then all your middle level objectives, then all your high-level
objectives.
Goal(s):
Indicate
TWS
objectives
with *
Objective
# (use to
code your
objectives)
Stated Objective
Level of
objective
Domain of
objective (cognitive,
(Low, middle, or
high)
affective, or psychomotor)
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Factor 3. Instructional Design and Implementation
Include as Attachment #1 a copy of your pre-assessment and post assessment items/activities.
This can be a copy of the assessment with the correct answers provided. The pre/post
assessment must measure all TWS objectives identified in Factor 2. Attachments do not count as
part of your 25 pages.
A) Design for Instruction Table (add rows as needed)
Timeline
Learning
Objectives (use
your coding
from Factor 2 to
save space)
Instructional
Activities,
including
interdisciplinary
activities
Resources
Assessments
and
Technology
Teaching and
Reading adaptations
for specific students
and subgroups*
based on identified
contextual and/or
pre-assessment needs
Day 1
Day 2
etc.
* Subgroups should be no smaller than 10% of the total class.
B) Narrative
1) Explanation of how the instructional plan addresses multiple types/levels of learning
throughout the unit
2) Explanation of how adaptations effectively address the specifically identified contextual needs
of the individuals, small group, or class.
3) Justification of how the unit actively engages students in questioning concepts, developing
learning strategies, seeking resources and conducting independent investigations.
4) Explanation of implementation of instructional strategies for student use of reading materials
related to the subject. Explanation of how these strategies incorporate techniques that allow for
assisting with a wide range of reading concerns and abilities.
5) Explanation of how technology makes a meaningful contribution to learning or a rationale is
given why it is inappropriate to use technology with students in this particular lesson.
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6) Explanation of how instructional design and implementation demonstrates knowledge of
specific factors in the students’ environment outside of school; how this knowledge is included in
the plan for instruction.
Factor 4. Demonstration of Integration Skills
A) Content areas being integrated (example: history, literature, music, etc.):
B) Topics within the subject being integrated (example: the civil war):
C) Explanation of how the instruction plan created learning experiences in which students
integrate knowledge, skill, and methods of inquiry from other subject areas, and within a subject
area. Reference specific days and activities from the Design for Instruction Table and specific
assessments from the Assessment Plan Table.
From other subject areas:
Within my subject area:
Factor 5. Analysis of Classroom Learning Environment
Continue to use the headings given in the template. Except for your classroom management plan,
your comments should be related to the specific unit.
(Checklist items)
A) Description of classroom environmental factors that affect learning
B) Description of individual student motivation strategies used
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C) Description of group motivation strategies used
D) Description of how verbal communication among students was developed
E) Description of how nonverbal communication among students was developed
(Rubric items)
F) Description of at least three classroom management strategies that will provide evidence of a
sufficient and comprehensive classroom management plan.
G) Description of motivational techniques used and how they are applied in the unit.
H) Evidence of effective student-to-student communication specific to the learning
I) Description of examples of inquiry learning that show an environment that involves students
in inquiry learning activities
J) Description of how students are actively involved in most learning activities and in
cooperative or group work.
Factor 6. Analysis of Assessment Procedures
Include as Attachment #1 a copy of your pre-assessment and post-assessment items/activities.
This can be a copy of the assessment with the correct answers provided. The pre/post
assessment must measure all TWS objectives identified in Factor 2. The attachments do not
count as part of your 25 pages.
A) Graphic representation of pre-assessment and post-assessment data. Disaggregated data for
at least one pair of subgroups. Subgroups should be no smaller than 10% of the total class. Note that a
table is not a graphic representation.
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B) Assessment Plan Table (add rows to the table as necessary)
Assessments
1. Preassessment
2. Formative
Assessment
3. Formative
Assessment
4. Formative
Assessment
(etc.)
5. Postassessment
TWS Objectives
(Use TWS Objectives
identified in Factor 2.)
Type of Assessment
(Include a brief description
and criteria for mastery.)
Adaptations
All TWS Objectives
.
All TWS Objectives
Same as pre-assessment.
C) Mastery Learning Table (add rows to the table as necessary; the cells with X’s do not require
data.)
TWS Objectives
Percentage
of Students
Achieving
Mastery on
each TWS
Objective
Average
Number of
Percentage
Students
of Students
Who
Achieving
Achieved
Mastery for
Mastery
each Level
with
of Objective Adaptations
Low level objectives:
XXXXX
Low Level Mastery Objective Index Sub-categories score.
(Average of percent of students achieving mastery of low level
objectives.)
XXXXX
XXXXX
Middle level objectives:
XXXXX
Middle Level Mastery Objective Index Sub-categories
Score. (Average of percent of students achieving mastery of middle level
XXXXX
XXXXX
objectives.)
High level objectives:
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High Level Mastery Objective Index Sub-categories Score.
(Average of percent of students achieving mastery of high level
objectives.)
Objective Mastery Index (Average of percentage of students achieving
mastery using all TWS Objectives.)
XXXXX
XXXXX
XXXXX
D) Table of learning gain scores and overall average gain. Include a table showing pre- and postassessment scores for each student, calculated gain score for each student, and the group average gain
score.
E) Describe subgroup performances on low, middle, and high level TWS Objectives. Provide
the number in each subgroup.
TWS Objectives
Subgroup 1:
(# in group)
Subgroup 2:
(# in group)
Low
Middle
High
If subgroup performances are different, explain why you think they are different or similar.
F) Explanation of how student progress was monitored by pre-assessment data and used
appropriately in instruction and decision-making.
G) Explanation of how student progress is monitored by assessment data and used in
instructional decision-making. Provide examples to illustrate.
H) Explanation of how student progress is monitored by appropriate post-assessment data and is
used appropriately in instructional decision-making or planning.
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I) Explanation why you have chosen each assessment you used to measure your TWS
Objectives.
J) Justify your assessment adaptations
Factor 7. Reflection and Self-Evaluation
(Have you deleted all of the text in red? How close to 25 pages are you now?)
A) Successful activities and assessments and plausible reasons for their success.
Unsuccessful activities and assessments and plausible reasons for their lack of success.
B) Explanation of use of evidence and data to support conclusions that student learning was
impacted, including description of any mid-unit adaptations. Explanation of two or more
hypotheses for why some students did not meet subject matter goals.
C) Three appropriate ideas for redesigning learning goals, instruction, or assessment and
explanation of why these changes would improve student learning.
D) Explanation of specific details of interactions with all three types of individuals: students,
parents and other professionals.
E) Explanation of the school improvement process and the role of the teacher in it.
F ) Explanation of two professional development goals that clearly emerge from the insights and
experiences described in this Factor and description of one activity to meet each goal.
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