Year:
Student Name:
University Supervisor’s Name:
School:
School District:
Cooperating Teacher:
Program Faculty Chair: Dr. Margaret Mohr-Schroeder
Observation 1 Date:
Subject/Class:
Time:
Observer:
Observation 2 Date:
Subject/Class:
Time:
Observer:
Observation 3: KTIP Observation and Form Observation 4 Date:
Subject/Class:
Time:
Observer:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
1

Instructions: Please rate the student teacher on their extent to achieve the corresponding criterion. Each criterion is linked with a standard, which is identified in the first column (text read vertically).
E= Exemplary (advanced indicator on KTS; not expected to attain)
D = Indicator Demonstrated
PD = Indicator Partially Demonstrated
ND = Indicator Not Demonstrated
N/A = Not Applicable
Standard/Indicator
Exemplary (E)
Advanced Indicator for KTS
Indicator
Demonstrated (D)
Indicator Partially
Demonstrated (PD)
Indicator Not
Demonstrated (ND)
To what extent does the student teacher exhibit the corresponding
Kentucky Teacher
Standard
Performance
Criteria?
Standard 1: The Teacher Demonstrates Applied Content Knowledge: The teacher demonstrates a current and sufficient academic knowledge of certified content areas to develop student knowledge and performance in those areas
Communicates concepts, processes, and knowledge
Accurately and effectively communicates and indepth understanding of concepts, processes, and/or knowledge in ways that contribute to the learning of all students
Accurately communicates concepts, processes and/or knowledge and uses vocabulary that is clear, correct and appropriate
Accurately communicates concepts, processes and knowledge but omits some important ideas, and/or uses vocabulary inappropriate for students
Inaccurately and ineffectively communicates concepts, processes and knowledge
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
2

Connects content to life experiences of students
Explicitly connects content to students’ life experiences including, when appropriate, prior learning in the content area or other content areas
Connects content, procedures, and activities with relevant life experiences of students
Connects some content, procedures, and activities with relevant life experiences of students
Fails to connect content, procedures, and activities with relevant life experiences of students
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Demonstrates instructional strategies that are appropriate for content and contribute to student learning
Consistently uses instructional strategies that are appropriate for content and contribute to the learning of all students
Uses instructional strategies that are appropriate for the content and processes of the lesson
Uses instructional strategies that are somewhat appropriate for the content and processes of the lesson
Fails to use instructional strategies that are appropriate for the content and processes of the lesson or make no contribution to student learning
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Identifies and addresses students’ misconceptions of content
Consistently anticipates misconceptions related to content and addresses them explicitly by using appropriate instructional practices.
Identifies misconceptions related to content and addresses them during both planning and instruction
Identifies misconceptions related to content and addresses them during either planning or instruction but not both
Fails to identify and address misconceptions related to content during planning and instruction
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
3

Guides students to understand content from various perspectives
Provides opportunities and guidance for students to consider lesson content from different perspectives
Observation 4
E D PD ND N/A
Comments:
Standard 2: The Teacher Designs and Plans Instruction: The teacher designs/plans instruction that develops student abilities to use communication skills, apply core concepts, become self-sufficient individuals, become responsible team members, think and solve problems, and integrate knowledge.
Develops significant objectives aligned with standards
Develops challenging and appropriate learning objectives that are aligned with local/state/national standards and are based on students’ needs, interests, and abilities
States learning objectives that reflect key concepts of the discipline and are clearly aligned with local or state standards
States learning objectives that reflect key concepts of the discipline but are not always or clearly aligned with local or state standards or states learning objectives that do not reflect key concepts of the discipline
Uses objectives that are not clearly stated or are trivial, and/or are not aligned with local or state standards
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Regularly guides students to understand content from appropriate diverse, multicultural, or global perspectives
Sometimes provides opportunities and guidance for students to consider lesson content from different perspectives
Fails to provide opportunities and guidance for students to consider lesson content from different perspectives
Plans assessments to guide instruction and measure learning objectives
Develops welldesigned assessments that align with learning objectives, guide instruction, and measure learning results
Prepares assessments that measure student performance on each objective and help guide teaching
Prepares some assessments that measure student performance and help guide teaching, but may not address all objectives
Prepares few assessments that measure student performance on objectives and/or help guide teaching.
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
© 2009 Burns & Mohr-Schroeder, University of Kentucky
4

Comments:
Plans instructional strategies and activities that address learning objectives for all students
Strategically plans a learning sequence using instructional strategies and activities that build on students’ prior knowledge and address learning objectives
Aligns instructional strategies and activities with learning objectives for all students
Aligns some instructional strategies and activities with learning objectives for all students
Aligns few instructional strategies and activities with learning objectives for all students
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Uses contextual data
(cultural, ethnic, special needs, ESL, IEP, etc.) to design relevant instruction to students
Plans and designs instruction that is based on significant contextual and preassessment data
Plans and designs instruction based on contextual (i.e., student, community, and/or cultural) and pre-assessment data
Plans and designs some instruction based on contextual (i.e., student, community, and/or cultural) and pre-assessment data
Fails to plan and design instruction based on contextual (i.e., student, community, and/or cultural) and pre-assessment data
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Plans instructional strategies and activities that facilitate multiple levels of learning
Plans a learning sequence using strategies and activities that explicitly foster the development of higher-order thinking
Plans instructional strategies that include several levels of learning that require higher order thinking
Plans instructional strategies that include at least two levels of learning with at least one requiring higher order thinking
Plans instructional strategies that do not include levels of learning or do not require higher order thinking
Observation 4
E D PD ND N/A
Comments:
Standard 3: The Teacher Creates and Maintains Learning Climate: The teacher creates a learning climate that supports the development of student abilities to use communication skills, apply core concepts, become self-sufficient individuals, become responsible team members, think and solve problems, and integrate knowledge.
© 2009 Burns & Mohr-Schroeder, University of Kentucky
5

Communicates high expectations
Consistently sets significant and challenging behavioral and learning expectations for all students and explicitly communicates confidence in their ability to achieve these expectations
Sets significant and challenging objectives for students and communicates confidence in students' ability to achieve these objectives
Sets significant objectives for students but does not communicate confidence in students' ability to achieve these objectives
Fails to set significant and challenging objectives for students and does not communicate confidence in students
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Establishes a positive learning environment
Consistently maintains a fair, respectful, and productive classroom environment conducive to learning
Establishes clear standards of conduct, shows awareness of student behavior, and responds in ways that are both appropriate and respectful of students
Makes efforts to establish standards of conduct, and monitor and respond to student behavior, but efforts are sometimes ineffective and/or inappropriate
Fails to establish clear expectations for student conduct, and does not effectively monitor behavior, and/or does not appropriately respond to behavior
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Fosters mutual respect between teacher and students and among students
Consistently treats all students with respect and concern and actively encourages students to treat each other with respect and concern
Treats all students with respect and concern and monitors student interactions to encourage respect and concern
Sometimes treats students with respect and concern and sometimes monitors student interactions to encourage respect and concern
Fails to treat students with respect and concern and/or monitor student interactions to encourage respect and concern
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
© 2009 Burns & Mohr-Schroeder, University of Kentucky
6

Comments:
Provides a safe environment for learning
Explicitly fosters and maintains a classroom environment that is both emotionally and physically safe for all students.
Creates a classroom environment that is both emotionally and physically safe for all students
Creates a classroom environment that is sometimes emotionally and physically safe for all students
Fails to create an emotionally and physically safe environment for students
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Values and supports student diversity and addresses individual needs
Consistently uses appropriate and responsive instructional strategies that address the needs of all students
Uses a variety of strategies and methods to support student diversity by addressing individual needs
Sometimes uses a variety of strategies and methods to support student diversity by addressing individual needs
Fails to use a variety of strategies and methods to support student diversity by addressing individual needs
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Standard 4: The Teacher Implements and Manages Instruction: The teacher introduces/implements/manages instruction that develops student abilities to use communication skills, apply core concepts, become self-sufficient individuals, become responsible team members, think and solve problems, and integrate knowledge.
© 2009 Burns & Mohr-Schroeder, University of Kentucky
7

Uses time effectively
Consistently makes thoughtful choices about the organization and implementation of both instructional and non-instructional tasks to maximize time for student learning.
Establishes efficient procedures for performing noninstructional tasks, handling materials and supplies, managing transitions, and organizing and monitoring group work so that there is minimal loss of instructional time
Establishes procedures for performing noninstructional tasks, handling materials and supplies, managing transitions, and organizing and monitoring group work that vary in their effectiveness so there is some unnecessary loss of instructional time
Fails to establish procedures for performing noninstructional tasks, handling materials and supplies, managing transitions, and organizing and monitoring group work resulting in significant loss of instructional time
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Uses instructional time effectively and transitions smoothly and logically from one activity to another
Strategically designs instructional sequences and transitions that allow the lesson to flow smoothly and logically across all activities in ways that enhance student learning
Consistently begins class when the bell rings; consistently transitions smoothly and logically from one activity to another, keeping the class running productively from bell to bell
Generally begins class on time, but may be inconsistent; AND/OR some transitions are smooth and logical while others are not;
AND/OR does not have students consistently working from bell to bell
Rarely begins class when the bell rings,
AND/OR consistently lacks clear transitions during the lesson,
AND/OR does not have students working from bell to bell
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
8

Uses space and materials effectively
Consistently makes optimal use of classroom space and uses a variety of instructional resources and technologies to enhance student learning.
Regularly uses classroom space and materials to facilitate student learning
Sometimes uses classroom space and materials effectively to facilitate student learning.
Fails to use classroom space and materials effectively to facilitate student learning
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Implements and manages instruction in ways that facilitate higher order thinking
Consistently uses a variety of appropriate and explicit strategies to facilitate higherorder thinking.
Instruction provides opportunity to promote higher-order thinking
Instruction provides some opportunity to promote higher-order thinking
Instruction provides little or no opportunity to promote higherorder thinking
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Uses a variety of instructional strategies that align with learning objectives and actively engage students.
Consistently provides a well-planned sequence of appropriate instructional strategies that actively engage students in meeting learning objectives
Uses a variety of instructional strategies that engage students throughout the lesson on tasks aligned with learning objectives
Uses a variety of instructional strategies that engage students throughout the lesson on tasks but are not aligned with learning objectives and/or tasks are aligned with objectives but do not keep students engaged
Fails to use instructional strategies that engage students and are aligned with learning objectives
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
9

Implements instruction based on diverse student needs and assessment data
Consistently implements instruction based on contextual information and assessment data, adapting instruction to unanticipated circumstances
Implements instruction based on contextual information and assessment data
Implements instruction based on limited use of contextual information and assessment data
Fails to implement instruction based on contextual information and assessment data
Observation 4
E D PD ND N/A
Comments:
Standard 5: The Teacher Assesses and Communicates Learning Results: The teacher assesses learning and communicates results to students and others with respect to student abilities to use communication skills, apply core concepts, become self-sufficient individuals, become responsible team members, think and solve problems, and integrate knowledge.
Uses formative assessments
Consistently uses appropriate formative assessments to determine student progress, guide instruction, and provide feedback to students.
Uses a variety of formative assessments to determine each student’s progress and guide instruction
Uses some formative assessments to determine each student’s progress and guide instruction
Fails to use formative assessments to determine each student’s progress and guide instruction
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Uses summative assessments
Consistently uses appropriate summative assessments aligned with the learning objectives to measure student achievement
Uses a variety of summative assessments to measure student achievement
Uses some summative assessments to measure student achievement
Fails to use summative assessments to measure student achievement
Observation 4
E D PD ND N/A
Comments:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
10

Communicates learning results to students and parents.
Clearly and explicitly communicates to students and parents in a timely manner the evidence of student performance and recommends future actions.
Communicates learning results to students and parents that provide a clear and timely understanding of learning progress relative to objectives
Sometimes communicates learning results to students and parents that provide a clear and timely understanding of learning progress relative to objectives
Fails to communicate learning results to students and parents that provide a clear and timely understanding of learning progress relative to objectives
Observation 4
E D PD ND N/A
Comments:
Uses pre-assessments
Consistently uses student baseline data from appropriate preassessments to promote the learning of all students.
Uses a variety of preassessments to establish baseline knowledge and skills for all students
Uses some preassessments to establish baseline knowledge and skills for all students
Fails to use preassessments to establish baseline knowledge and skills for all students
Observation 4
E D PD ND N/A
Comments:
Describes, analyzes, and evaluates student performance data
Consistently describes, analyzes, and evaluates student performance data to determine student progress, identify differences among student groups, and inform instructional practice.
Describes, analyzes, and evaluates student performance data to determine progress of individuals and identify differences in progress among student groups
Evaluates student performance data to determine progress of individuals but does not identify differences in progress among student groups
Fails to describe, analyze, or evaluate student performance data to determine progress of individuals or identify differences in progress among student groups
Observation 4
E D PD ND N/A
Comments:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
11

Allows opportunity for student selfassessment
Provides explicit ongoing opportunities for students to assess and reflect on their own performance in order to identify strengths and areas for future learning.
Promotes opportunities for students to engage in accurate selfassessment of learning
Promotes some opportunities for students to engage in accurate selfassessment of learning
Fails to promote opportunities for students to engage in accurate selfassessment of learning
Observation 4
E D PD ND N/A
Comments:
Standard 6: The Teacher Demonstrates the Implementation of Technology: The teacher uses technology to support instruction; access and manipulate data; enhance professional growth and productivity; communicate and collaborate with colleagues, parents, and the community; and conduct research.
Uses available technology to design and plan instruction
Strategically uses appropriate technology to design and plan instruction that supports and extends learning of all students.
Uses technology to design and plan instruction
Sometimes uses technology to design and plan instruction
Rarely or never uses technology to design and plan instruction.
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
12

Demonstrates ethical and legal use of technology
Provides and maintains a safe, secure, and equitable classroom environment that consistently promotes discerning and ethical use of technology.
Ensures uses of technology are ethical and legal
Sometimes ensures that personal use and student use of technology are ethical and legal
Fails to ensure that personal use and student use of technology are ethical and legal
Observation 1
E D PD ND N/A
Observation 2
E D PD ND N/A
Observation 4
E D PD ND N/A
Comments:
Uses available technology to implement instruction that facilitates student learning
Designs and implements researchbased, technologyinfused instructional strategies to support learning of all students.
Comments:
Integrates student use of available technology into instruction
Provides varied and authentic opportunities for all students to sue appropriate technology to further their learning.
Comments:
Uses available technology to assess and communicate student learning
Uses technology to assess student learning, manage assessment data, and communicate results to appropriate stakeholders.
Comments:
Uses technology to implement instruction that facilitates student learning
Integrates student use of technology into instruction to enhance learning outcomes and meet diverse student needs
Uses technology to assess and communicate student learning
Sometimes uses technology to implement instruction that facilitates student learning
Rarely or never uses technology to implement instruction and facilitate student learning
Observation 4
E D PD ND N/A
Sometimes integrates student use of technology into instruction to enhance learning outcomes and meet diverse student needs
Rarely or never integrates student use of technology into instruction to enhance learning outcomes and meet diverse student needs
Observation 4
E D PD ND N/A
Sometimes uses technology to assess and communicate student learning
Rarely or never uses technology to assess and communicate student learning
Observation 4
E D PD ND N/A
© 2009 Burns & Mohr-Schroeder, University of Kentucky
13

Observer Notes and Comments:
Standard 9: Evaluates Teaching and Implements Professional Development
The teacher evaluates his/her overall performance with respect to modeling and teaching Kentucky’s learning goals, refines the skills and processes necessary, and implements a professional development plan.
 Self assesses performance relative to Kentucky’s Teacher Standards

Identifies priorities for professional development based on data from self-assessment, student performance, and feedback from colleagues

Designs a professional growth plan that address identified priorities

Shows evidence of professional growth and reflection on the identified priority areas and impact on instructional effectiveness on student learning
Areas of Strength identified by the observer:
Areas of Growth identified by the observer:
My Signature below documents that this observation and evaluation assessment has been shared and discussed with me.
Student Teacher:
Cooperating Teacher:
University Supervisor:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
14

Observer Notes and Comments:
Standard 9: Evaluates Teaching and Implements Professional Development
The teacher evaluates his/her overall performance with respect to modeling and teaching Kentucky’s learning goals, refines the skills and processes necessary, and implements a professional development plan.
 Self assesses performance relative to Kentucky’s Teacher Standards

Identifies priorities for professional development based on data from self-assessment, student performance, and feedback from colleagues

Designs a professional growth plan that address identified priorities

Shows evidence of professional growth and reflection on the identified priority areas and impact on instructional effectiveness on student learning
Areas of Strength identified by the observer:
Areas of Growth identified by the observer:
My Signature below documents that this observation and evaluation assessment has been shared and discussed with me.
Student Teacher:
Cooperating Teacher:
University Supervisor:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
15

Observer Notes and Comments:
Standard 9: Evaluates Teaching and Implements Professional Development
The teacher evaluates his/her overall performance with respect to modeling and teaching Kentucky’s learning goals, refines the skills and processes necessary, and implements a professional development plan.
 Self assesses performance relative to Kentucky’s Teacher Standards

Identifies priorities for professional development based on data from self-assessment, student performance, and feedback from colleagues

Designs a professional growth plan that address identified priorities

Shows evidence of professional growth and reflection on the identified priority areas and impact on instructional effectiveness on student learning
Areas of Strength identified by the observer:
Areas of Growth identified by the observer:
My Signature below documents that this observation and evaluation assessment has been shared and discussed with me.
Student Teacher:
Cooperating Teacher:
University Supervisor:
© 2009 Burns & Mohr-Schroeder, University of Kentucky
16