Education Service Center
6611 Boeing Drive Alternative Certification
Region 19
El Paso, Texas 79925 PH: 915-780-5065
El Paso & Hudspeth Counties
www.esc19.net
FAX: 915-780-5010
Teacher Preparation & Certification Program
Mentor Observation Report – Hired (AE-F053.0)
Mentor Teacher: Observe your intern teacher for one class period (approximately 45 minutes), and take
notes on what you observed. Submit completed form to intern upon completion. You will need to complete a
total of six observations during the internship year: three in the fall and three in the spring.
Date:_______________ Time In: _______ Time Out: _______ Observation Number: _______
Name of Intern: ________________________________
Name of Mentor: _______________________________
School/Campus: ________________________ Grade(s)/Subject(s) Observed: _________________________
Area(s) Observed:
• Large Group Instruction
• Individual Instruction
• Other ___________________
• Small Group Instruction
• Discipline Mgt.
Lesson Objective: _________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Instructional Strategies: ____________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Management Strategies: ____________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Positive Aspects of the Lesson: _______________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Suggestion(s) and Recommendation(s) for instruction and/or discipline:_______________________________
________________________________________________________________________________________
________________________________________________________________________________________
Was progress noted from prior observation(s)?
• Yes • No
• N/A
___________________________________
Mentor Signature
________________________________________________________________________________
10/22/14
AE-F053.0
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