DISTRICT DISTINGUISHED TEACHER EVALUATION
Please submit this completed application to the School Leadership Department. Incomplete applications will not be considered.
Applicant
Name: Date application submitted:
Current school of employment: Grade/Dept:
Total years of teaching experience: Years in Harrison District 2:
Use the sheets in this packet to submit your responses for items 2 through 5 below.
1) Copy of most recent summative evaluation including the Student
Achievement Distribution for subject area or grade level taught
2) Evidence of demonstrated leadership outside the classroom (Limit
– 2 pages)
3) Evidence of being a lifelong learner (Limit
– 2 pages)
4) Evidence of contributions to the profession (Limit – 2 pages)
5) Daily classroom schedule for March 31 and the months of April and May, including days when instruction may be impacted by building activities (i.e., fieldtrips, assessment, etc.)
Teacher Signature: __________________________________ Date: _________________
Administrator Name: _______________________________________________________
Signature: _________________________________________ Date: ________________
2014-15 School Year

DISTRICT DISTINGUISHED TEACHER EVALUATION
Evidence of demonstrated leadership outside the classroom
Please describe examples of recent leadership experiences. Examples of leadership experience might include training colleagues on “The Write Tools”; organizing a professional book club around best practices in instruction; chairing the budget committee; leading the alignment process in the building; attending and successfully completing a leadership program; serving on and actively participating on a District-level committee or subcommittee such as the CDMT, QFT, DAC, etc; service on a Building Leadership Team, service as a Curriculum Collaborator, or as a Department Chair. Use no less than 12 point font.
2014-15 School Year

DISTRICT DISTINGUISHED TEACHER EVALUATION
Evidence of being a lifelong learner
Please provide evidence of your professional growth & development. You must have completed or be enrolled in classes/workshops that are focused on improving instruction within the last three years. Examples of lifelong learning include completing a workshop on the Response to Intervention model; taking an advanced degree course in technology; attending a conference on professional learning communities; or watching video tapes of one’s teaching to improve her practice. Use no less than 12 point font.
2014-15 School Year

DISTRICT DISTINGUISHED TEACHER EVALUATION
Evidence of contributions to the profession
Please describe how you support others in the profession of education. Examples of contributions to the profession include collaborating and supporting colleagues; providing professional development; serving as a mentor to new teacher(s); participating in a professional association or organization; presenting at conferences; teaching a university class; or writing for a professional journal or website. Please provide dates and references for each activity. Use no less than 12 point font.
2014-15 School Year