Cleveland State University
Teacher as a Responsive, Reflective Professional: A Partner in Learning
College of Education and Human Services
Intern Observation and Formative Assessment Form – AYA Mathematics
Step 1: Preparing for the Observation
1. Intern sends an electronic copy of the lesson plan to the supervisor and mentor at least 24 hours prior to the
observation. Supervisor stores lesson plan document on OFS-supplied USB drive.
2. Observer may request intern to provide a hard copy of the plan for use during the observation.
Step 2: Completing the Observation Form
1. Take notes during observation and complete Observation Form afterwards with scores and comments. If you
wish to provide the intern with immediate feedback (optional), you may choose to leave a copy of your notes
with the intern.
2. If available, use licensure-specific Observation Form. If a licensure-specific form is unavailable, use the generic
form.
3. Choose any one of 3 formats: 1) Word 97-03 fill-in form; 2) a Word 2007 fill-in form; or 3)unprotected Word
2007 document. Fill-in forms feature automatic calculations but do not allow spell-check. Use unprotected
forms carefully if you wish to use spell check.
4. Fill in all heading information. Include at least 3 comments in each domain. Use “Specific Comments” to
summarize the lesson and identify 2-4 opportunities for further growth.
5. With fill-in forms, calculate averages by right-clicking each highlighted field (Mac computers use Ctrl-Click) and
selecting “Update field.” If formulas do not calculate correctly, calculate scores manually and enter averages in
the fill-in fields.
Step 3: Completing the Observation
1. Intern completes Follow-Up Form and submits to observer within two days of the observation.
2. E-mail electronic copy of the Observation Form to intern after receiving the Follow-up Form but within one week
of the observation. Copy supervisor and mentor teacher so everyone has electronic copies of the form.
3. Record averages on Field Experience Record and Evaluation Form (hard copy on NCR paper) and obtain intern’s
initials at the next available opportunity.
4. Supervisor stores electronic copies of the following documents in the student’s folder on the OFS-supplied USB
drive:
a. Lesson plan
b. Observation Form
c. Follow-up Form
Intern:
Date of Lesson:
School:
Mentor/CTE:
Completed by:
Grade Level/Subject:
Supervisor:
Observation #:
Performance Levels:
Scores:
Supervisor
Date of PostConference:
1
Exemplary (E)
Proficient (P)
Emerging (M)
Unsatisfactory (U)
Not attempted
4
3.5
3
2.5
2
1
0
Note: All items must be scored for each observation using the available evidence for sub-items.
Domain A. Organizing Content Knowledge for
Student Learning
Score
Comments
Primarily completed prior to observation using lesson plan
A1.
A2.
A3.
A4.
A5.
A6.
A7.
Use of student background information for planning
instruction
 Plans relate to intern’s knowledge of students.
 Plans accommodate for needs of English language learners and students
with exceptionalities.
 Plans vary instruction based on students’ background.
 Plans demonstrate cultural competence by incorporating instructional
content, resources, and strategies that are responsive to cultural,
linguistic, and gender differences.
Instructional goals and objectives
 Plans establish clear goals.
 Plans establish measurable objectives.
 Goals and objectives relate to varied learning styles.
 Goals and objectives establish appropriate expectations for all students.
 Goals and objectives relate to Ohio Academic Content Standards and are
aligned with school curriculum.
Content of instructional plans
 Plans demonstrate correct sequencing of subject matter.
 Plans demonstrate accurate content knowledge.
 Plans demonstrate cross-disciplinary connections where appropriate.
Structure of planned activities and materials
 Structure of lesson is developmentally appropriate for students and
subject matter.
 Activities and materials match with identified instructional goals.
 Activities and materials are appropriate for students’ diverse needs and
characteristics.
Assessment
 Plan includes varied assessment strategies to measure the achievement
of instructional goals and objectives.
 Assessment strategies are appropriate for students.
Licensure-Specific Items
Selects and uses appropriate concrete materials for learning
mathematics.
Demonstrates knowledge of research results in the teaching
and learning of mathematics.
Is plan readily available for mentor and supervisor?
3 comments minimum per domain; highlight effective
practices and provide specific suggestions for
improvement.
Domain B. Enhancing the Learning Environment
Score
Comments
Primarily completed using notes from the observation
B1.
B2.
B3.
B4.
B5.
Fairness to students
 Intern establishes a climate of courtesy and respect
 Intern makes eye contact with students.
 Intern shows impartiality by involving all students.
Rapport with students
 Intern expresses interest in students and knows students’ names.
 Intern shows enthusiasm and appropriate tone.
 Intern establishes positive rapport with students.
Challenging expectations for learners
 Intern encourages students to ask questions.
 Intern provides students with choices in learning.
 Intern encourages students to pursue further learning.
Classroom management skills
 Intern states specific, appropriate expectations for classroom behavior
and states reasons for expectations.
 Intern applies rules consistently and fairly.
 Intern maintains students’ attention throughout the lesson.
 Intern promotes positive behavior.
Physical environment
 Intern maintains a safe learning environment.
 Intern enhances student learning with bulletin boards/displays of student
work.
 Intern uses space and materials to vary physical environment to meet
students’ needs and instructional goals.
3 comments minimum per domain; highlight effective
practices and provide specific suggestions for
improvement.
Domain C. Teaching for Student Learning
Score
Comments
Primarily completed using notes from the observation
C1.
C2.
C3.
C4.
C5.
C6.
C7.
Communicating goals and procedures
 Intern makes goals and objectives clear to students.
 Intern makes instructional procedures clear to students.
Communicating content
 Intern conveys content clearly and accurately.
 Intern uses correct language, spelling, and syntax in verbal and written
explanations of content.
 Intern clarifies content for students having difficulty understanding.
Structure and sequence of instructional activities
 Intern uses lesson structure and sequence that is developmentally
appropriate for students and subject matter.
 Intern uses a variety of individual and collaborative learning activities to
achieve learning goals.
 Intern uses appropriate manipulatives and instructional materials to
support student learning.
 Intern uses appropriate available technology to support student learning.
 Intern provides appropriate adaptations for English language learners
and students with exceptionalities.
Extending student thinking
 Intern structures specific learning activities that encourage students to
extend their thinking.
 Intern recognizes and uses opportunities to help students extend their
thinking.
 Intern uses questioning and other interaction strategies to foster
students’ understanding and to stimulate creative and critical thinking.
 Intern allows sufficient wait-time for student response to questions.
Assessing student understanding
 Intern uses questioning and a variety of other appropriate assessment
strategies to gauge student learning.
 Intern correctly interprets students’ verbal and non-verbal cues for levels
of understanding.
 Plan includes varied assessment strategies to measure the achievement
of instructional goals and objectives.
 Assessment strategies are appropriate for students.
Use of assessment
 Intern keeps written documentation of assessments to track student
learning over time.
 Intern adjusts instruction/activities based on formative assessment and
uses teachable moments to meet students’ needs.
 Intern monitors students and gives them substantive feedback.
Intern uses evaluation results in planning future instruction.
Use of time




C8.
C9.
C10.
Instructional materials are ready prior to the lesson.
Intern sues routines and procedures to maximize instructional time.
Intern paces the lesson appropriately for the students and content.
Intern makes smooth transitions between instructional activities to
maximize instructional time.
Licensure-specific items
Demonstrates the ability to lead classes in mathematical
problem solving and in developing in-depth conceptual understanding,
and to help students develop and test generalizations.
Develops students’ ability to know, understand, and apply the
process of mathematical problem solving.
Develops students’ ability to reason, construct, and evaluate
mathematical arguments and develop an appreciation for mathematical
rigor and inquiry.
3 comments minimum per domain; highlight effective
practices and provide specific suggestions for
improvement.
C11.
C12.
C13.
Develops students’ ability to communicate their
mathematical thinking orally and in writing to peers, faculty, and others.
Develops students’ ability to recognize, use, and make
connections between and among mathematical ideas and in contexts
outside mathematics to build mathematical understanding.
Develops students’ ability to use varied representations of
mathematical ideas to support and deepen mathematical understanding.
Domain D. Professionalism
Score
Comments
Primarily completed after the observation, based on feedback
from mentor teacher in conversation with the intern and
mentor teacher. NOTE: Scores in this domain reflect
cumulative performance in each indicator and are averaged
independently of the the observation score.
D1.
D2.
D3.
D4.
D5.
Reflection and professional development
 Intern uses self-reflection to recognize and correct weaknesses.
 Intern reflects on student achievement of the learning goals.
 Intern uses feedback from prior observations to improve instruction.
Completion of work in the field
 Intern follows school policies to maintain accurate student records and
grades.
 Intern performs assigned professional duties in the classroom.
 Intern demonstrates initiative in getting involved in the classroom and
working with the mentor.
Collaboration
 Intern requests professional assistance from appropriate sources.
 Intern establishes professional rapport with mentor and supervisor.
 Intern maintains appropriate oral and written communication with
families.
Professional habits in the field
 Intern follows school policies.
 Intern displays dispositions listed on the CSU List of Student Dispositions
(including punctuality, attendance, and appropriate appearance) in the
field.
 Intern participates in additional contractual teacher obligations as
required by the experience (planning meetings, faculty meetings, parentteacher conferences, professional development activities, school
functions).
 Intern uses appropriate vocabulary and correct grammar/punctuation in
verbal and written communication.
Professional habits in seminar
 Intern displays dispositions listed on the CSU List of Student Dispositions
(including punctuality, attendance, and active participation) in the
seminar and with the supervisor.
 Intern completes all assignments and submits written work, including
portfolio artifacts, in a timely fashion as assigned by supervisor, seminar
leader, or mentor teacher.
 Intern uses appropriate vocabulary and correct grammar/punctuation in
verbal and written communication.
3 comments minimum per domain; highlight effective
practices and provide specific suggestions for
improvement.
Specific Comments
Provide a brief summary of the lesson and include 2-4 suggestions for the intern to consider for the next lesson.
Domain A
Domain B
Domain C
Domain A-C
Averages
0.00
0.00
0.00
Domain D
Average
0.00
Observation
Overall
0.00
To calculate averages,
Right click on each field in the table to the
left and select “Update field”.
If formulas don’t work in the table above, use the table below to enter the calculated values manually.
Domain A
Domain B
Domain C
Observation Overall
Domain D
Domain Averages
The complete formal observation record must contain the following written materials:
 Intern’s written lesson plan (copies of handouts or assessments not required)
 Intern Observation Form—completed by observer, signed and dated by intern and observer
 Observation Follow-up Form—completed by intern