Harrison School District Two
Summative Evaluation Report
SSP – School Psychologist
(For school psychologists on the E&R Plan)
Name:
Department:
Name of Evaluator:
Date of the Summative:
School Year:
Assignment:
Building(s) Served:
Data sources upon which conclusions are drawn and findings are based:
Spot Observations
Informal Observations
Formal Observations
Student Outcomes
Professional Growth Plans
SSP Products
Parent and/or student survey data
Peer or community input
Memos and letters
Awards and recognitions
Other:
Date of
Pre-Observation
Conference
1st Semester
2nd Semester
Optional
Spot Observations
st
1 Semester
2nd Semester
Dates:
Date/Time
of
Formal Observation
/
/
/
/
Date of
Post-Observation
Conference
Harrison School District Two
SSP Summative Evaluation Report
School Psychologist
Overall Performance Rating
Standard 1. Planning and Preparation
Unsatisfactory
(1)
1a.
1b.
1c.
1d.
Progressing I
Progressing II
(2)
Proficient I
(3)
(4)
Proficient II
(5)
Proficient III
Exemplary
(6)
(7)
Establish and maintain clear and organized procedures for referrals.
Establish session goals or meeting outcomes.
Plan interventions, accommodations & modifications to maximize likelihood of student success.
Apply knowledge of state and federal regulations and of resources both within and beyond the school
and district.
Standard 2. Data Informed Decision Making
Unsatisfactory
(1)
2a.
Progressing I
Progressing II
(2)
(3)
Proficient I
(4)
Proficient II
(5)
Proficient III
Exemplary
(6)
(7)
Evaluate student needs in compliance with the National Association of School Psychologists (NASP)
guidelines.
Demonstrate knowledge & skill in using psychological instruments to evaluate students.
Analyze and use results from multiple sources or assessments in decision making.
Provide appropriate feedback.
Utilize technology to gather data and enhance the learning environment.
2b.
2c.
2d.
2e.
Standard 3. Delivery of Service
Unsatisfactory
(1)
3a.
3b.
3c.
3d.
3e.
3f.
Progressing I
(2)
Progressing II
(3)
Proficient I
(5)
Proficient II
(6)
Proficient III
Exemplary
(7)
(8)
Respond to referrals; consulting with teachers and administrators.
Assume director designee responsibilities.
Ensure sessions or meetings are focused and productive while promoting active participation.
Use a variety of materials, methods, and strategies to remove barriers to learning.
Demonstrate flexibility and responsiveness.
Maintain contact with physicians and community mental health service providers.
Standard 4. Interventions
Unsatisfactory
(1)
4a.
4b.
4c.
4d.
Progressing I
(2)
Progressing II
(3)
Proficient I
(4)
Proficient II
(5)
Proficient III
(6)
Exemplary
(7)
Implement or monitor academic interventions.
Recommend, implement or monitor appropriate interventions for students with social, emotional &
behavioral needs.
Use appropriate tools for identifying early warning signs of children at risk and implement pre-referral
interventions for learning and social/emotional behavioral problems.
Participate as a member of an intervention or solution team.
School Psychologist
Standard 5. Contributions to the Learning Environment
Unsatisfactory
(1)
5a.
5b.
5c.
Progressing I
(2)
Progressing II
(3)
Proficient I
(4)
Proficient II
(5)
Proficient III
Exemplary
(6)
(7)
Model positive and respectful rapport.
Respect diversity among others.
Ensure that students with special needs are placed within the Least Restrictive Environment (LRE).
Standard 6. Leadership
Unsatisfactory
(1)
6a.
Progressing I
(2)
Progressing II
(3)
Proficient I
(4)
Proficient II
(5)
Proficient III
Exemplary
(6)
(7)
Understand their role and responsibility in implementing the District, Department and/or Building Action
Plan.
Promote the concept of Professional Learning Communities through purposeful involvement.
Continue professional growth.
Support collaborative partnerships.
Supervise volunteers and paraprofessionals – when applicable.
6b.
6c.
6d.
6e.
Standard 7. Professional Responsibilities
Unsatisfactory
(1)
7a.
Progressing I
(2)
Progressing II
(3)
Proficient I
(4)
Proficient II
(5)
Proficient III
Exemplary
(6)
(7)
Adhere to federal laws, state statutes and regulations pertaining to education, the Board of Education
(BOE) policies, the Agreement of Trust and Understanding (ATU), and school rules.
Demonstrate professionalism.
Effectively communicate.
Maintain confidentiality.
Solve problems.
Perform assigned and related duties.
7b.
7c.
7d.
7e.
7f.
With the exception of the conditions outlined below, total the points for each rating of standards 1-7 (points
are in parenthesis).

A school psychologist with two or more unsatisfactory ratings in any standard would receive an overall
rating of Unsatisfactory with a score of 8.

A school psychologist with one unsatisfactory rating in any standard would receive an overall rating of
Progressing I with a score of 11.
Evaluation of Performance
Unsatisfactory
Progressing I
Progressing II
Proficient I
Proficient II
Proficient III
Exemplary
0-10
11-17
18-24
25-31
32-38
39-45
46-50
Harrison School District Two
Summative Evaluation Report – School Psychologist
Evaluation Summary
Evaluation of Performance
1
Points Earned:
[See Performance Standards Rubrics]
Unsat
Prog. I
Prog. II
Prof. I
Prof. II
Prof. III
Exemplary
0-10
11-17
18-24
25-31
32-38
39-45
46-50
Evaluation of Student Outcomes
2
Points Earned:
[See Assigned Distribution]
Unsat
Prog. I
Prog. II
Prof. I
Prof. II
Prof. III
Exemplary
0-7
8-15
16-22
23-34
35-43
44-47
48-50
Add the total points recorded above for section 1 to the points earned from the student outcomes distribution in section 2.
Subset Summary
Combined Performance and Student Outcomes
Unsat.
Prog. I
Prog. II
Prof. I
Eligible for Dist. Eval. **
0-18
19-33
34-47
48-66
67-100
** To be eligible for a Distinguished SSP Evaluation, a school psychologist must score at
least 32 points on the performance evaluation and at least 35 points on the student
outcomes template, must have attained a Proficient II or higher student outcomes rating
for two out of the past three years, and must currently have a minimum Overall
Effectiveness Level of Proficient I. School psychologists who do not meet this criteria are
only eligible for a 1-step increase in Overall Effectiveness Level, not to exceed Proficient I.
 Unsatisfactory on performance will result in an overall unsatisfactory evaluation.
School Psychologist
School Psychologist’s Overall Summative Rating
Eligible for District Distinguished Evaluation
Proficient I
Progressing II
Progressing I
Unsatisfactory
Evaluator Comments (required)
Strengths:
Recommended Areas of Growth:
Note: unsatisfactory ratings must always be supported with a written explanation
School Psychologist
Eligible for District Distinguished SSP Evaluation (initial one of the following)
SSP agrees to submit an application for a District Distinguished Evaluation within three
weeks of signing this document. Evaluation process will continue with the
Distinguished Evaluation Form attached. ______ (initials)
SSP is not currently a distinguished SSP and declines invitation to
submit an application for a District Distinguished Evaluation for the current school year.
SSP’s summative evaluation rating is “Proficient I.” ______ (initials)
SSP is currently a distinguished SSP and declines invitation to submit an application
for District Distinguished Evaluation for the current school year. SSP’s summative
evaluation rating is determined by adding performance points and student outcome
points up to the current overall effectiveness level. SSP understands that a District
Distinguished Evaluation is required to advance in effectiveness level. ______ (initials)
Distinguished SSPs who elect not to submit an application for District Distinguished
Evaluation are required to participate in a “Paper Review” every second year to
maintain their distinguished status. The SSP initials one of the following if declining
to submit an application for District Distinguished Evaluation:
The distinguished SSP has attained a summative evaluation rating equivalent to or
higher than the current distinguished overall effectiveness level. ______ (initials)
 A Paper Review application will be submitted. (circle one) YES NO
The distinguished SSP has declined in summative evaluation rating. The SSP
understands this drop represents a year of effectiveness decline. Two consecutive
years of effectiveness decline will result in a decrease of one overall effectiveness
level. _____ (initials)
 A Paper Review application will be submitted. (circle one) YES NO
School Psychologist
I have reviewed this evaluation and discussed it with my evaluator. My signature indicates
that I have been advised of my performance status; it does not necessarily imply that I
agree with this evaluation.
Provider’s Signature:
Date:
Evaluator’s Signature:
Date:
Evaluator’s Supervisor Signature:
Date:
The Evaluator’s Supervisor Signature on this form verifies that the report has been
reviewed and that the proper procedure appears to have been followed.
Harrison School District Two
Summative Evaluation Report – School Psychologist
Distinguished SSP Evaluation Form: To be completed by the Distinguished
Evaluation Review Team
1
Distinguished Evaluation (District level review)
[Attach Distinguished Evaluation Rubric.]
Criteria
Actual service delivery
Leadership
Lifelong learning
Contributions to the profession
Weight
2x
1x
1x
1x
Rubric Pts.
Total
/20
/10
/10
/10
/50
GRAND TOTAL
Prof. I
< 35
2
Prof. II
35-37
Prof. III
38 - 41
Exem. I
42 - 45
Exem. II
> 45
Evaluation of Student Outcomes
(From the score on the student outcomes distribution, must be Proficient II or higher)
Prof. II
Prof. III
Exemplary
35-43
44-47
48-50
Combined Distinguished Evaluation Performance
Score and Student Outcomes
Summary
Prof. I
Prof. II
Prof. III
Exem. I or II
<70
70-81
82-89
90-100

An SSP who receives an Exemplary II rating from the distinguished review team and whose student
outcomes score results in an Exemplary rating (at least 48 points) is placed at the Exemplary II
effectiveness level.

An SSP will be considered a “Master” SSP if he or she has been rated at the Exemplary II level for at
least two years in a row and has either earned a national board certification in his or her assignment area
or has successfully served for at least one academic year in an impoverished District school outside of
their home school(s) as determined by the District.
Exemplary II
Master
School Psychologist
School Psychologist’s Overall Summative Rating
Master
Exemplary II
Exemplary I
Proficient III
Proficient II
Proficient I
I have reviewed this evaluation and discussed it with my evaluator. My signature indicates
that I have been advised of my performance status; it does not necessarily imply that I
agree with this evaluation.
Provider’s Signature:
Date:
Evaluator’s Signature:
Date:
Evaluator’s Supervisor Signature:
Date:
The Evaluator’s Supervisor Signature on this form verifies that the report has been
reviewed and that the proper procedure appears to have been followed.