SCHOOL PSYCHOLOGIST DATA COLLECTION FORM
(Information completed on this form should be gathered from specific products and behaviors such as observations, work
samples, Extra-curricula activities, professional development activities, etc.)
Evaluatee ________________________________________ Content Area/Grade(s)
Evaluator ________________________________________ Position
________________________
_______________________________________
Observation Information:
Date ___________________________
What is observed? ______________________________________________________
Time ___________________________
Standards (No.'s) ________________________________________________________
(If more room is needed for recording purposes, use plain paper and attach to this form using a continuation of the page
numbering format depicted on each page.)
School Psychologist Performance Standards
Standard1: Demonstrates Professional Leadership.
1.1 Builds positive relationship with and between
school communities.
1.3 Participates in professional organizations.
1.2 Promotes leadership potential in colleagues.
1.4 Writes and speaks effectively.
1.5 Practices effective listening, conflict resolutions,
1.6 Accepts and utilize constructive feedback to promote
and group-facilitation skills as a team member with
professional growth.
respect for diverse ideas.
1.7 Adheres to school board polices and administrative
1.8 Adheres to the state professional Code of Ethics.
procedures.
Professional Development Comments and/or Concerns for STANDARD 1
Standard 2: Demonstrates Knowledge and Competence in Assessment Procedures
2.1 Competently completes a variety of observations for
students being evaluated.
2.3 Is knowledgeable of a variety of education
assessment instruments and techniques.
2.5 Is knowledgeable in selecting procedures and in
conducting functional behavioral assessments or
functional analysis of behavior.
2.7 Analyzes student performance in relation to process
in general education curriculum.
2.2 Is able to establish rapport with students to maximize
performance.
2.4 Effectively selects assessment instruments appropriate
for the students’ age, needs, and suspected disability.
2.6 Competently administers, scores, and interprets
assessments.
2.8 Works well with each student’s evaluation team to
integrate information, make decisions, and generate
recommendations.
2.10 Prepares professionally written integrated reports in
conjunction with the evaluation team.
2.9 Recommendations are linked to strengths and
weaknesses resulting form analysis of assessment
findings.
2.11 Adheres to policies for completing reports within specified timelines.
Professional Development Comments and/or Concerns for STANDARD 2
Standard 3: Engages in Professional Development.
3.1 Establishes priorities for professional growth.
3.2 Analyzes the needs of the student to help identify
personal professional development needs.
3.4 Applies knowledge, skills, and processes acquired
through professional development.
3.2 Maintains knowledge of educational trends,
disabilities, and assessment instruments.
3.5 Modifies own professional development plan to
improve student learning.
Professional Development Comments and/or Concerns for STANDARD 3:
Standard 4: Demonstrates Implementation of Technology
4.1 Installs and uses a variety of assessment scoring
software.
4.2 Uses terminology related to computers and assistive
technology appropriately in written and verbal
communication.
4.3 Demonstrates basic knowledge of
4.4 Uses computer for word processing, to create databases
computer/peripheral parts and attends to simple
and spreadsheets, and to access electronic mail and the
connections and installations.
internet.
4.5 Makes recommendations as appropriate for assistive 4.6 Practices legal use of computers and technology in
and adaptive devices for students with special needs. activities.
Professional Development Comments and/or Concerns for STANDARD 4:
Standard 5: Demonstrates knowledge of federal and state guidelines and district procedures that govern special
education.
5.1 Demonstrates knowledge of referral process.
5.2 Demonstrates knowledge of evaluation process.
5.3 Knowledgeable of and adheres to timelines for
completing evaluations.
5.5 Respects confidentiality of privileged information.
5.4 Demonstrates knowledge of eligibility requirements for
special education.
5.6 Takes district goals and objectives into consideration
during the planning process.
5.7 Demonstrates knowledge of legal issues of students identified with disabilities.
Professional Development Comment and/or Concerns for STANDARD 5:
Standard 6: Communicates effectively with Students, Administrators, Parents, Teachers, and Significant
Community Members.
6.1 Communicates high expectations for all students.
6.2 Works cooperatively with colleagues.
6.3 Interacts effectively with students, staff, and
6.4 Provides consultative support to school based as
parents.
needed.
6.5 Consults and problem solve to assist with
6.6 Serves as a resource for information for parents and
determining individual needs of a student and assists
staff.
with developing intervention plans.
6.7 Seeks direction from other professionals or support
6.8 Participates in decision making for program planning
staff as needed.
and development of individual education plans.
6.9 Communicates effectively with community
6.10 Provides a link between those responsible for the
agencies and resources.
child’s progress both in school and beyond.
Professional Development Comments and/or Concerns for STANDARD 6:
Standard 7: Demonstrates Good Time Management Which Promotes Effective Performance
7.1 Demonstrates punctuality and good attendance for
7.2
all duties.
7.3 Priorities multiple tasks in a manner that promotes
7.4
completion within specified timelines.
7.5 Demonstrates flexibility in adapting to necessary changes.
Organizes time efficiently to meet requirements for
assigned responsibilities.
Demonstrates the ability to accomplish tasks under
pressure.
Professional Development Comments and/or Concerns for STANDARD 7
Standard 8: Utilizes Effective Strategies in Providing Support Services to Students, Staff, and Parents
8.1 Provides a safe, confidential setting in which
8.2 Communicates empathy and understanding with
students present their needs and concerns.
others.
8.3 Utilizes effective procedures for responding to
8.4 Uses a broad range of techniques and accepted theories
counseling referrals.
appropriate to school counseling.
8.5 Intervenes in problem/conflict situations and
8.6 Identifies specific needs of the student and develop a
conducts follow-up sessions.
service delivery plan.
8.7 Implements procedures to evaluate effectiveness of 8.8 Works cooperatively with staff and parents to ensure
service delivery plan.
generalization of targeted skills.
8.9 Identifies appropriate and available resources both
8.10 Provides assistance to students in crisis.
within and outside the school system.
8.11 Facilitates process for referral to community
8.12 Maintains records for documentation of service
agencies when appropriate and in accordance with
delivery.
district policies.
Professional Development Comments and/or Concerns for STANDARD 8:
Standard 9: Engages in activities that promote prevention.
9.1 Maintains knowledge of research based practices
9.2 Engages in activities that assist with anticipating and
that promote effective prevention activities and
monitoring needs within the school and individual
strategies.
students within the school in efforts to increase
prevention efforts.
9.3 Is aware of factors within the school community
9.4 Works cooperatively with assigned schools, district
that may impact prevention activities.
staff, and community representatives to identify needs
of individual or district schools in efforts to develop and
implement interventions.
9.5 Assists with developing procedures for follow-up measuring effectiveness of programs or interventions.
Professional Development Comments and/or Concerns for STANDARD 9
Other comments, observations, or concerns: