Rubric for Work Sample
National
Standards
Components
CAEP 1
INTASC 1,2,3
A.1 Teaching
Context/
A.2
Describing the
Work Sample
A.2, A.3
Assessment/
Impact on
Student
Learning
CAEP 1
INTASC 4,5,6
CAEP 1
INTASC 6,7,9
A.3, A.4, A.5,
A.6
Assessment
Plan
CAEP 1
INTASC
4,5,6,7,8
A.7
Work Sample
Lesson Plans
CAEP 1
INTASC 4
A.7 Alignment
Content
Target
Forms completed with detailed
descriptions of classroom
conditions.
Acceptable
Forms missing any information;
vague description of classroom
conditions. I have questions about
the Work Sample
Unacceptable
Forms missing more than half the
information; no classroom
conditions described.
Work Sample positively affects
student learning. Describes multiple
assessment tools aligned with
objectives and instruction. Uses
results of assessment to guide and
modify instruction.
Work Sample. Describe the preand post assessment method(s).
Summative assessment is
performance and requires HOTS.
Pre- and post assessments are
analyzed and efforts to remediate
unsuccessful students included.
Detailed information provided
about communication and followup. All responses are detailed and
logical.
Five full lesson plans with printed
materials, assessment, and rubrics
attached. At least three lessons
include hands-on activities. At least
two lessons contain cooperative
grouping as well as other valid
teaching strategies other than
lecture.
All five lessons contain CCSS/
GLEs, objectives, activities, and
assessment and all are aligned.
Lessons are aligned with National
Content Standards
Work Sample positively affects
student learning. Describes two
assessment tools aligned with
objectives and instruction. Uses
results of assessment to guide
instruction.
Describe the assessment plan for
the Work Sample. Describe the
pre- and post assessment
method(s). Summative assessment
is not performance but requires
HOTS. Pre- and post assessments
are analyzed and efforts to
remediate unsuccessful students
included. Information provided
about communication and followup.
Four full lesson plans included or
lessons are missing one key
component. At least two lessons
include hands-on activities. No
cooperative grouping in any
lessons. Lecture dominates 2 or
more lessons. Other valid teaching
strategies used.
All five lessons contain CCSS/
GLEs, objectives, activities, and
assessment and all are aligned.
Any mis-alignment with National
Content Standards.
Work Sample does not positively
affect student learning. Describes
one assessment tool, but not
aligned with objectives and
instruction.
Describe the assessment plan for
the Work Sample. Describe the
pre- and post assessment
method(s). Summative
assessment is not performance nor
requires HOTS. Pre- and post
assessments are analyzed but
efforts to remediate unsuccessful
students not included. Responses
are vague with little supporting
verbiage.
Fewer than four lesson plans
included or are missing more than
one key component. Only one
lesson includes hands-on
activities. No cooperative
grouping in any lessons. Lecture
dominates lessons.
Fewer than five lessons contain
CCSS/GLEs, objectives, activities,
and assessment or non-alignment
noted in two or more lessons.
III. Work Sample
Entry A  The Work Sample is a body of instruction in one subject area for one class. The Work Sample includes 1) plans for
instruction and assessment that are aligned with the learning outcomes desired; 2) the teaching of the content; and 3) the collection,
interpretation, and reflection upon evidence of student progress toward attainment of the desired learning outcomes.
A 1.
Teaching Context
I. Class/Classroom Information
Grade levels in class (list all that apply)______
Ages in class (list all that apply)____________
# Students enrolled_______________________
# Typically Present ______________________
Time available each day to teach content of work sample __________________
Place an X beside the phrase that describes the resources (equipment, technology, and supplies)
available for this class.
___well-equipped/supplied ___ adequately equipped/supplied ____ poorly equipped/supplied
Place an X beside the phrase that describes the number of teaching interruptions.
___few
___some
___many
Place an X beside the phrase that describes the types of help available to you.
___instructional assistant(s)
___parent volunteers
___peer (student) tutors
___resource teachers
___other (Please specify.)____________________________
2
II. Individual Differences
Indicate the # of students in each category below.
_____ ESL
_____ # with IEPs or IFSPs
_____ Title I
_____ Gifted
_____ # with 504 modifcations
_____ Other
Indicate the # of students for each pattern of achievement.
_____ Low
_____ Average
_____ High
Enter low (L), medium (M), or high (H) to describe the level of diversity for each category below.
_____ Ages _____ Languages _____ Cultures _____ Achievement/Developmental Levels
Enter the appropriate label(s) for the # of students with each learning style listed below.
None (0)
Few (1-3)
Many (more than 3)
________ Print ________ Auditory ________ Interactive
________ Visual
________ Tactile _______ Kinesthetic _______ Other
Describe any other classroom conditions (if any) that have caused you to adjust your instruction in
some way.
3
A 2. Describing the Work Sample
1. Subject Area:
Grade:
2. Length of Unit (# of days/class periods)
3. Learning Objectives/Outcomes to be accomplished by students. (List each day’s objective.)
Day 1Day 2Day 3Day 4Day 5Additional days4. Rationale for Objectives/Outcomes- (How are objectives real and relevant to the students’ lives?)
5. Adjustments made to accommodate one or more of the categories of individual differences:
VisualAuditoryKinestheticTactileOther-
4
A.3 The Assessment Plan
1. Describe the assessment plan for this Work Sample. (Describe pre-assessment, daily formal and
informal assessment and post-assessment.) Note: A copy of the pre-assessment and postassessment must be attached.
2. How do you know that your objectives, pre-assessment, instruction, and post-assessment were
aligned? Please explain.
5
A 4. Analyzing the Results
Analyzing the Result
Student
(List students here. Do not use
full names!)
PreAsses
s-ment
PostAsses
s-ment
Gain
+ or -
Did student meet
objectives?
Pre
Ye
s
1.
2.
3.
4.
5.
Attach additional pages to include all students.
6
Comments
(If student showed any regression or significant
gains, you must comment.)
PreNo
Post
-Yes
PostNo
A 5. Reflecting on the Impact of Instruction
Use Information from A4 in the synthesis and interpretation of the impact of instruction.
A 5. Reflecting on the Impact of Instruction
1. How many students accomplished all of the objectives you established for this body
of instruction? What % of students did not meet all objectives? What factors
contributed to their success/failure?
2. Describe the circumstances/conditions that contributed to the poor achievement of
students who did not meet the objectives or make substantial gains.
3. Since the conclusion of the Work Sample, what have you done to help students who
did not accomplish/master the objectives to improve their learning in these areas?
4. What impact will the information gained from your reflection about your students’
performance have on future lessons? Describe specific adjustments you will make in
your instruction.
7
A 6. Communication and Follow-Up
1. Describe several ways in which you will introduce and provide feedback about the work
sample. What information will you provide to the groups listed below prior to instruction,
during instruction, and after the post-assessment? How will you communicate that
information?
■
Students
■
Parents/Caregivers
2. How will you use the information gained as a result of your communications? Be
specific. (Don’t just tell me you will use it to plan future lessons.)
A 7. Work Sample Lesson Plan
A7 is used to provide data for many of the critical elements of instructional planning. All lesson plans that were taught as
part of the Work Sample must be included as the final entry for the first section of your portfolio. You must include at least 5
full lessons submitted on the LSUS approved lesson plan template.
8
Teacher:
Grade:
Alignment to Standards
Subject:
Unit Theme:
Date: Day 1
Write out CCSS standards
Learner Objective(s)
TLW: Be sure that objectives are aligned to the standards and they are measurable. Do not use “using” or
“by”.
Academic Vocabulary
List the academic vocabulary that you will teach during this lesson. You may acknowledge if the words fall
into Tier 1, Tier 2, Tier 3. There’s a link in Moodle for more information about Tiered Vocabulary.
Lesson Materials and Resources
Bell ringer –
First Five
M- what student use to learn
Technology
A-what teachers use to teach
Hardware:-Active Board, document camera, etc
S-items that are not a part of the adopted
Software:-Star, Spelling City, Accelerated Math
teacher materials
A quick assignment that is completed at the start of class. Journal, Daily Oral Language, Math facts
Instructional Activities-Introductory
Question for prior knowledge
Establishing Prior Knowledge
Communicate Purpose and
Relevance
Restate Objective and explain why this information is important to students.
Motivation
3-5 minute grab, variety here
Instructional Input:
Include Differentiation
Modeling
(I DO)
9
Introduce content to students.
Demonstrate what is expected of the students.
Checking for Understanding
Guided Practice
(WE DO)
Independent Practice
(YOU DO)
Formal and Informal Assessment
Questioning, monitoring progress, walking around
Work through content with students.
Allow students time to work and provide feedback as needed.
FACTS sheet ideas, can’t be independent practice
Assessment for Learning
Remediation/Early Finishers
Remediation is what the teacher will do. Early Finishers should be challenged with assignments that extend
learning.
Closure
Question students
Home Learning
Involve family/community members
Special Needs /Accommodations
Class Demographics
10
Individual Accommodations: Highlight or
star all accommodations used
Independent Study
Paired Learning
Preferential Seating
504 Modifications
Learning Styles
Monitor Students
Male:
Female:
Small Group
Cooperative Groups
Visual Aids
Use of manipulatives
Reduce Distractions
Oral Reading
Model/Repeat/Modify
Shorten Assignment
Review/Drill
Study Guide/Outline
Allow breaks
Other:
Caucasian:
Hispanic:
African American:
Special Needs Students:
(IEP, Gifted, 504)
11
Teacher:
Grade:
Alignment to Standards
Subject:
Unit Theme:
Date: Day 2
Write out CCSS standards
Learner Objective(s)
TLW: Be sure that objectives are aligned to the standards and they are measurable. Do not use “using” or
“by”.
Academic Vocabulary
List the academic vocabulary that you will teach during this lesson. You may acknowledge if the words fall
into Tier 1, Tier 2, Tier 3. There’s a link in Moodle for more information about Tiered Vocabulary.
Lesson Materials and Resources
Bell ringer –
First Five
M- what student use to learn
Technology
A-what teachers use to teach
Hardware:-Active Board, document camera, etc
S-items that are not a part of the adopted
Software:-Star, Spelling City, Accelerated Math
teacher materials
A quick assignment that is completed at the start of class. Journal, Daily Oral Language, Math facts
Instructional Activities-Introductory
Question for prior knowledge
Establishing Prior Knowledge
Communicate Purpose and
Relevance
Restate Objective and explain why this information is important to students.
Motivation
3-5 minute grab, variety here
Instructional Input:
Include Differentiation
Modeling
(I DO)
12
Introduce content to students.
Demonstrate what is expected of the students.
Checking for Understanding
Guided Practice
(WE DO)
Independent Practice
(YOU DO)
Formal and Informal Assessment
Questioning, monitoring progress, walking around
Work through content with students.
Allow students time to work and provide feedback as needed.
FACTS sheet ideas, can’t be independent practice
Assessment for Learning
Remediation/Early Finishers
Remediation is what the teacher will do. Early Finishers should be challenged with assignments that extend
learning.
Closure
Question students
Home Learning
Involve family/community members
Special Needs /Accommodations
Class Demographics
13
Individual Accommodations: Highlight or
star all accommodations used
Independent Study
Paired Learning
Preferential Seating
504 Modifications
Learning Styles
Monitor Students
Male:
Female:
Small Group
Cooperative Groups
Visual Aids
Use of manipulatives
Reduce Distractions
Oral Reading
Model/Repeat/Modify
Shorten Assignment
Review/Drill
Study Guide/Outline
Allow breaks
Other:
Caucasian:
Hispanic:
African American:
Special Needs Students:
(IEP, Gifted, 504)
14
Teacher:
Grade:
Alignment to Standards
Subject:
Unit Theme:
Date: Day 3
Write out CCSS standards
Learner Objective(s)
TLW: Be sure that objectives are aligned to the standards and they are measurable. Do not use “using” or
“by”.
Academic Vocabulary
List the academic vocabulary that you will teach during this lesson. You may acknowledge if the words fall
into Tier 1, Tier 2, Tier 3. There’s a link in Moodle for more information about Tiered Vocabulary.
Lesson Materials and Resources
Bell ringer –
First Five
M- what student use to learn
Technology
A-what teachers use to teach
Hardware:-Active Board, document camera, etc
S-items that are not a part of the adopted
Software:-Star, Spelling City, Accelerated Math
teacher materials
A quick assignment that is completed at the start of class. Journal, Daily Oral Language, Math facts
Instructional Activities-Introductory
Question for prior knowledge
Establishing Prior Knowledge
Communicate Purpose and
Relevance
Restate Objective and explain why this information is important to students.
Motivation
3-5 minute grab, variety here
Instructional Input:
Include Differentiation
Modeling
(I DO)
15
Introduce content to students.
Demonstrate what is expected of the students.
Checking for Understanding
Guided Practice
(WE DO)
Independent Practice
(YOU DO)
Formal and Informal Assessment
Questioning, monitoring progress, walking around
Work through content with students.
Allow students time to work and provide feedback as needed.
FACTS sheet ideas, can’t be independent practice
Assessment for Learning
Remediation/Early Finishers
Remediation is what the teacher will do. Early Finishers should be challenged with assignments that extend
learning.
Closure
Question students
Home Learning
Involve family/community members
Special Needs /Accommodations
Class Demographics
16
Individual Accommodations: Highlight or
star all accommodations used
Independent Study
Paired Learning
Preferential Seating
504 Modifications
Learning Styles
Monitor Students
Male:
Female:
Small Group
Cooperative Groups
Visual Aids
Use of manipulatives
Reduce Distractions
Oral Reading
Model/Repeat/Modify
Shorten Assignment
Review/Drill
Study Guide/Outline
Allow breaks
Other:
Caucasian:
Hispanic:
African American:
Special Needs Students:
(IEP, Gifted, 504)
17
Teacher:
Grade:
Alignment to Standards
Subject:
Unit Theme:
Date: Day 4
Write out CCSS standards
Learner Objective(s)
TLW: Be sure that objectives are aligned to the standards and they are measurable. Do not use “using” or
“by”.
Academic Vocabulary
List the academic vocabulary that you will teach during this lesson. You may acknowledge if the words fall
into Tier 1, Tier 2, Tier 3. There’s a link in Moodle for more information about Tiered Vocabulary.
Lesson Materials and Resources
Bell ringer –
First Five
M- what student use to learn
Technology
A-what teachers use to teach
Hardware:-Active Board, document camera, etc
S-items that are not a part of the adopted
Software:-Star, Spelling City, Accelerated Math
teacher materials
A quick assignment that is completed at the start of class. Journal, Daily Oral Language, Math facts
Instructional Activities-Introductory
Question for prior knowledge
Establishing Prior Knowledge
Communicate Purpose and
Relevance
Restate Objective and explain why this information is important to students.
Motivation
3-5 minute grab, variety here
Instructional Input:
Include Differentiation
Modeling
(I DO)
18
Introduce content to students.
Demonstrate what is expected of the students.
Checking for Understanding
Guided Practice
(WE DO)
Independent Practice
(YOU DO)
Formal and Informal Assessment
Questioning, monitoring progress, walking around
Work through content with students.
Allow students time to work and provide feedback as needed.
FACTS sheet ideas, can’t be independent practice
Assessment for Learning
Remediation/Early Finishers
Remediation is what the teacher will do. Early Finishers should be challenged with assignments that extend
learning.
Closure
Question students
Home Learning
Involve family/community members
Special Needs /Accommodations
Class Demographics
19
Individual Accommodations: Highlight or
star all accommodations used
Independent Study
Paired Learning
Preferential Seating
504 Modifications
Learning Styles
Monitor Students
Male:
Female:
Small Group
Cooperative Groups
Visual Aids
Use of manipulatives
Reduce Distractions
Oral Reading
Model/Repeat/Modify
Shorten Assignment
Review/Drill
Study Guide/Outline
Allow breaks
Other:
Caucasian:
Hispanic:
African American:
Special Needs Students:
(IEP, Gifted, 504)
20
Teacher:
Grade:
Alignment to Standards
Subject:
Unit Theme:
Date: Day 5
Write out CCSS standards
Learner Objective(s)
TLW: Be sure that objectives are aligned to the standards and they are measurable. Do not use “using” or
“by”.
Academic Vocabulary
List the academic vocabulary that you will teach during this lesson. You may acknowledge if the words fall
into Tier 1, Tier 2, Tier 3. There’s a link in Moodle for more information about Tiered Vocabulary.
Lesson Materials and Resources
Bell ringer –
First Five
M- what student use to learn
Technology
A-what teachers use to teach
Hardware:-Active Board, document camera, etc
S-items that are not a part of the adopted
Software:-Star, Spelling City, Accelerated Math
teacher materials
A quick assignment that is completed at the start of class. Journal, Daily Oral Language, Math facts
Instructional Activities-Introductory
Question for prior knowledge
Establishing Prior Knowledge
Communicate Purpose and
Relevance
Restate Objective and explain why this information is important to students.
Motivation
3-5 minute grab, variety here
Instructional Input:
Include Differentiation
Modeling
(I DO)
21
Introduce content to students.
Demonstrate what is expected of the students.
Checking for Understanding
Guided Practice
(WE DO)
Independent Practice
(YOU DO)
Formal and Informal Assessment
Questioning, monitoring progress, walking around
Work through content with students.
Allow students time to work and provide feedback as needed.
FACTS sheet ideas, can’t be independent practice
Assessment for Learning
Remediation/Early Finishers
Remediation is what the teacher will do. Early Finishers should be challenged with assignments that extend
learning.
Closure
Question students
Home Learning
Involve family/community members
Special Needs /Accommodations
Class Demographics
22
Individual Accommodations: Highlight or
star all accommodations used
Independent Study
Paired Learning
Preferential Seating
504 Modifications
Learning Styles
Monitor Students
Male:
Female:
Small Group
Cooperative Groups
Visual Aids
Use of manipulatives
Reduce Distractions
Oral Reading
Model/Repeat/Modify
Shorten Assignment
Review/Drill
Study Guide/Outline
Allow breaks
Other:
Caucasian:
Hispanic:
African American:
Special Needs Students:
(IEP, Gifted, 504)