Notre Dame of Maryland University – PDS Partnership
Supervisor Sign-Off
Supervisors: Complete one sign-off sheet for each intern you supervise. Submit all sign-off sheets to PDS Coordinators,
Stephanie Savick or Juliann Dupuis (via email or by campus mailbox) at the close of each semester. Two copies of all formal
observations go to the intern’s advisor.
Supervisor: ______________________________________________
Semester: Fall Spring Year______________
Intern: ___________________________________________________
Type: GEI
Intern Program:
Math
ACT MAT Undergrad
Elementary/Early Childhood
English
Science
Social Studies
Foreign Language
Spec. Ed.
TESOL
First Placement School for Intern: _______________________________________________
Name of Mentor: ____________________________________________________
First Placement Triad Date: ________________________________
First Formal Observation Date: ____________________ Rating: Satisfactory Developing Unsatisfactory
Second Formal Observation Date: _________________ Rating: Satisfactory Developing
Unsatisfactory
Placement I Verification of Submission Document Attached
Supervisor Initials
Date Action Research/Intervention Project was presented during placement I
Date:_______________________Location:______________________________
----------------------------------------------------------------------------------------------------------------------------- ----Second Placement School: ________________________________________________________
Name of Mentor: ________________________________________________
Second Placement Triad Date: ____________________________________________
Third Formal Observation Date: _____________________ Rating: Satisfactory Developing Unsatisfactory
Fourth Formal Observation Date: ___________________ Rating: Satisfactory Developing Unsatisfactory
Placement II Verification of Submission Document Attached
Supervisor Initials
----------------------------------------------------------------------------------------------------------------------------- ----Date of Exit Interview: _____________________________________________
Location:____________________________
Date Action Research/Intervention Project was presented during placement II
Date:_______________________Location:______________________________
Notre Dame of Maryland University – PDS Partnership
Record of E-Portfolio Assignment Scores for All Certification Areas
Assignment
Score
Differentiated Lesson Plan
Strategies Lesson Plan
Observational of Instructional Competence
Motivational Strategies and Classroom Management Plan
Assistive Technology
Observational of Instructional Planning
RSVP Practice Essay
Assessment Lesson Plan with Re-Teaching
Standardized Assessments Chart
Final Disposition Form
Professional Educational Philosophy
RSVP Self-Reflection Essay
Post-Internship Interview
Parent Communication Form
Intervention Project/Action Research
Mentor Level II Evaluation
Record of Assignment Scores by Program/Content Area – Complete for Program
Elementary and Early Childhood Candidates
Score
Early Childhood Assessment by Mentor
Elementary Exit Interview
Secondary English Candidates
Oral Communication Skills
Literature Circle Discussion
Multicultural Instructional Practices in English Reflections
Foreign Language Candidates
Professional Development Activities
Secondary Mathematics Candidates
Technology Reflection
Problem Solving Lesson Plan
Capstone Essay
Case Study (with Pre-Post Test)
Mathematics Specific Disposition Form
Secondary Mathematics Internship Evaluation
Secondary Science Candidates
Science Internship
Effects on Students Learning Science
Secondary Social Studies Candidates
NCSS Performance-Based Evaluation
Secondary Social Studies Disposition Form
Secondary Social Studies Internship Evaluation
Secondary Social Studies Post-Internship Interview
Special Education Candidates
CEC Content Standards
SPE Effects on Student Learning
TESOL Candidates
TESOL Effects on Student Learning
Instructional Competence Summative Evaluation Form
Final grade submitted for intern: _____________