Teacher Summative Assessment Form
(To be completed by the teacher and administrator based on cumulative evidence) Teacher: Date: Evaluation: Winter/Spring Domain 1: Planning and Preparation
Component Target Level of Performance
Unsatisfactory/Basic/Proficient/Distinguished :
1b: Demonstrating knowledge of students
Teacher demonstrates little or no knowledge of students’ backgrounds, cultures, skills, language proficiency, interests, and special needs, and does not seek such understanding.
Teacher indicates the importance of understanding students’ backgrounds, cultures, skills, language proficiency, interests, and special needs, and attains this knowledge for the class as a whole.
Teacher actively seeks knowledge of students’ backgrounds, cultures, skills, language proficiency, interests, and special needs, and attains this knowledge for groups of students.
Teacher actively seeks knowledge of students’ backgrounds, cultures, skills, language proficiency, interests, and special needs from a variety of sources, and attains this knowledge for individual students.
Evidence: ( Briefly document evidence, if any, that supports this area)
1a: Demonstrating knowledge of content and pedagogy
Teacher’s plans and practice display little knowledge of the content, prerequisite relationships between different aspects of the content, or the instructional practices specific to that discipline.
Teacher’s plans and practice reflect some awareness of the important concepts in the discipline, prerequisite relations between them and of the instructional practices specific to that discipline.
Teacher’s plans and practice reflect solid knowledge of the content, prerequisite relations between important concepts and of the instructional practices specific to that discipline.
Teacher’s plans and practice reflect extensive knowledge of the content and structure of the discipline. Teacher actively builds on knowledge of prerequisites and misconceptions when describing instruction or seeking causes for student misunderstanding.
Evidence: ( Briefly document evidence, if any, that supports this area)
1c: Setting instructional outcomes
Instructional outcomes are unsuitable for students, represent trivial or low-level learning, or are stated only as activities. They do not permit viable methods of assessment.
Instructional outcomes are of moderate rigor and are suitable for some students, but consist of a combination of activities and goals, some of which permit viable methods of assessment. They reflect more than one type of learning, but teacher makes no attempt at coordination
Instructional outcomes are stated as goals reflecting high- level learning and curriculum standards. They are suitable for most students in the class, represent different types of learning, and are capable of assessment. The outcomes reflect opportunities for coordination.
Instructional outcomes are stated as goals that can be assessed, reflecting rigorous learning and curriculum standards. They represent different types of content, offer opportunities for both coordination and integration, and take account of the needs of individual students.
Evidence: ( Briefly document evidence, if any, that supports this area)
1d:Demonstrating knowledge of resources
Teacher demonstrates little or no familiarity with resources to enhance own knowledge, to use in teaching, or for students who need them. Teacher does not seek such knowledge.
Teacher demonstrates some familiarity with resources available through the school or district to enhance own knowledge, to use in teaching, or for students who need them. Teacher does not seek to extend such knowledge.
Teacher is fully aware of the resources available through the school or district to enhance own knowledge, to use in teaching, or for students who need them.
Teacher seeks out resources in and beyond the school or district in professional organizations, on the Internet, and in the community to enhance own knowledge, to use in teaching, and for students who need them.
Evidence: ( Briefly document evidence, if any, that supports this area)
D1 AVG:
Evidence: ( Briefly document evidence, if any, that supports this area)
1f: Designing student assessment
Teacher’s plan for assessing student learning contains no clear criteria or standards, is poorly aligned with the instructional outcomes, or is inappropriate to many students. The results of assessment have minimal impact on the design of future instruction.
Teacher’s plan for student assessment is partially aligned with the instructional outcomes, without clear criteria, and inappropriate for at least some students. Teacher intends to use assessment results to plan for future instruction for the class as a whole.
Teacher’s plan for student assessment is aligned with the instructional outcomes, using clear criteria, and is appropriate to the needs of students. Teacher intends to use assessment results to plan for future instruction for groups of students.
Teacher’s plan for student assessment is fully aligned with the instructional outcomes, with clear criteria and standards that show evidence of student contribution to their development. Assessment methodologies may have been adapted for individuals, and the teacher intends to use assessment results to plan future instruction for individual students.
1e: Designing coherent instruction
The series of learning experiences are poorly aligned with the instructional outcomes and do not represent a coherent structure. They are suitable for only some students.
The series of learning experiences demonstrates partial alignment with instructional outcomes, some of which are likely to engage students in significant learning. The lesson or unit has a recognizable structure and reflects partial knowledge of students and resources.
Teacher coordinates knowledge of content, of students, and of resources, to design a series of learning experiences aligned to instructional outcomes and suitable to groups of students. The lesson or unit has a clear structure and is likely to engage students in significant learning.
Teacher coordinates knowledge of content, of students, and of resources, to design a series of learning experiences aligned to instructional outcomes, differentiated where appropriate to make them suitable to all students and likely to engage them in significant learning. The lesson or unit’s structure is clear and allows for different pathways according to student needs.
Evidence: ( Briefly document evidence, if any, that supports this area)
Domain 2: The Classroom Environment
Component Target Level of Performance
2a: Creating an environment of respect and rapport
Component Target Level of Performance
Unsatisfactory Basic Proficient Distinguished
Evidence: ( Briefly document evidence, if any, that supports this area)
Classroom interactions, both between the teacher and students and among students, are negative, inappropriate, or insensitive to students’ cultural backgrounds, and characterized by sarcasm, put-downs, or conflict.
Classroom interactions, both between the teacher and students and among students, are generally appropriate and free from conflict but may be characterized by occasional displays of insensitivity or lack of responsiveness to cultural or developmental differences among
Classroom interactions, between teacher and students and among students are polite and respectful, reflecting general warmth and caring, and are appropriate to the cultural and developmental differences among groups of students.
Classroom interactions among the teacher and individual students are highly respectful, reflecting genuine warmth and caring and sensitivity to students’ cultures and levels of development. Students themselves ensure high levels of civility among members of the class.
Evidence: ( Briefly document evidence, if any, that supports this area)
2b: Establishing a culture for learning
The classroom environment conveys a negative culture for learning, characterized by low teacher commitment to the subject, low expectations for student achievement, and little or no student pride in work.
Teacher’s attempt to create a culture for learning is partially successful, with little teacher commitment to the subject, modest expectations for student achievement, and little student pride in work. Both teacher and students appear to be only “going through the motions.”
The classroom culture is characterized by high expectations for most students, genuine commitment to the subject by both teacher and students, with students demonstrating pride in their work.
High levels of student energy and teacher passion for the subject create a culture for learning in which everyone shares a belief in the importance of the subject, and all students hold themselves to high standards of performance: for example, by initiating improvements to their work.
2c: Managing classroom procedures
Much instructional time is lost due to inefficient classroom routines and procedures for transitions, handling of supplies, and performance of non- instructional duties.
Some instructional time is lost due to only partially effective classroom routines and procedures for transitions, handling of supplies, and performance of non- instructional duties.
Little instructional time is lost due to classroom routines and procedures for transitions, handling of supplies, and performance of non- instructional duties, which occur smoothly.
Students contribute to the seamless operation of classroom routines and procedures for transitions, handling of supplies, and performance of non- instructional duties.
Evidence: ( Briefly document evidence, if any, that supports this area)
2d: Managing student behavior
There is no evidence that standards of conduct have been established, and little or no teacher monitoring of student behavior. Response to student misbehavior is repressive, or disrespectful of student dignity.
It appears that the teacher has made an effort to establish standards of conduct for students. Teacher tries, with uneven results, to monitor student behavior and respond to student misbehavior.
Standards of conduct appear to be clear to students, and the teacher monitors student behavior against those standards. Teacher response to student misbehavior is appropriate and respects the students’ dignity.
Standards of conduct are clear, with evidence of student participation in setting them. Teacher’s monitoring of student behavior is subtle and preventive, and teacher’s response to student misbehavior is sensitive to individual student needs. Students take an active role in monitoring the standards of behavior.
Evidence: ( Briefly document evidence, if any, that supports this area)
D2 AVG:
2e: Organizing physical space
The physical environment is unsafe, or some students don’t have access to learning. There is poor alignment between the physical arrangement and the lesson activities.
The classroom is safe, and essential learning is accessible to most students, and the teacher’s use of physical resources, including computer technology, is moderately effective. Teacher may attempt to modify the physical arrangement to suit learning activities, with partial success.
The classroom is safe, and learning is accessible to all students; teacher ensures that the physical arrangement is appropriate to the learning activities. Teacher makes effective use of physical resources, including computer technology.
The classroom is safe, and the physical environment ensures the learning of all students, including those with special needs. Students contribute to the use or adaptation of the physical environment to advance learning. Technology is used skillfully, as appropriate to the lesson.
Evidence: ( Briefly document evidence, if any, that supports this area)
Domain 3 Rubric: Instruction
Component Target Level of Performance
Unsatisfactory Basic Proficient Distinguished
3b: Using questioning and discussion techniques
3a: Communicating with students
Expectations for learning, directions and procedures, and explanations of content are unclear or confusing to students. Teacher’s use of language contains errors or is inappropriate to students’ cultures or levels of development.
Expectations for learning, directions and procedures, and explanations of content are clarified after initial confusion; teacher’s use of language is correct but may not be completely appropriate to students’ cultures or levels of development.
Expectations for learning, directions and procedures, and explanations of content are clear to students. Communications are appropriate to students’ cultures and levels of development
Expectations for learning, directions and procedures, and explanations of content are clear to students. Teacher’s oral and written communication is clear and expressive, appropriate to students’ cultures and levels of development, and anticipates possible student misconceptions.
Evidence: ( Briefly document evidence, if any, that supports this area)
Teacher’s questions are low-level or inappropriate, eliciting limited student participation, and recitation rather than discussion.
Some of the teacher’s questions elicit a thoughtful response, but most are low- level, posed in rapid succession. Teacher’ attempts to engage all students in the discussion are only
Most of the teacher’s questions elicit a thoughtful response, and the teacher allows sufficient time for students to answer. All students participate in the discussion, with the teacher stepping aside
Questions reflect high expectations and are culturally and developmentally appropriate. Students formulate many of the high-level questions and ensure that all voices are heard.
Evidence: ( Briefly document evidence, if any, that supports this area)
3d: Using Assessment in Instruction
3c: Engaging students in learning
Activities and assignments, materials, and groupings of students are inappropriate to the instructional outcomes, to students’ cultures or levels of understanding, resulting in little intellectual engagement. The lesson has no structure or is poorly paced.
Activities and assignments, materials, and groupings of students are partially appropriate to the instructional outcomes, or to students’ cultures or levels of understanding, resulting in moderate intellectual engagement. The lesson has a recognizable structure but is not fully maintained.
Activities and assignments, materials, and groupings of students are fully appropriate to the instructional outcomes, and to students’ cultures and levels of understanding. All students are engaged in work of a high level of rigor. The lesson’s structure is coherent, with appropriate pace.
Students are highly intellectually engaged throughout the lesson in significant learning, and make material contributions to the activities, student groupings, and materials. The lesson is adapted as needed to the needs of individuals, and the structure and pacing allow for student reflection and closure.
Evidence: ( Briefly document evidence, if any, that supports this area)
Assessment is not used in instruction, either through students’ awareness of the assessment criteria, monitoring of progress by teacher or students, or through feedback to students.
Assessment is occasionally used in instruction, through some monitoring of progress of learning by teacher and/or students. Feedback to students is uneven, and students are aware of only some of the assessment criteria used to evaluate their work.
Assessment is regularly used in instruction, through self-assessment by students, monitoring of progress of learning by teacher and/or students, and through high quality feedback to students. Students are fully aware of the assessment criteria used to evaluate their work.
Assessment is used in a sophisticated manner in instruction, through student involvement in establishing the assessment criteria, self- assessment by students and monitoring of progress by both students and teachers, and high quality feedback to students from a variety of sources.
Evidence: ( Briefly document evidence, if any, that supports this area)
D3 AVG:
4a: Reflecting on Teaching
3e: Demonstrating flexibility and responsiveness
Teacher adheres to the instruction plan, even when a change would improve the lesson or students’ level of interest. Teacher brushes aside student questions; when students experience difficulty, the teacher blames the students or their home environment.
Teacher attempts to modify the lesson when needed and to respond to student questions, with moderate success. Teacher accepts responsibility for student success, but has only a limited repertoire of strategies to draw upon.
Teacher promotes the successful learning of all students, making adjustments as needed to instruction plans and accommodating student questions, needs and interests.
Teacher seizes an opportunity to enhance learning, building on a spontaneous event or student interests. Teacher ensures the success of all students, using an extensive repertoire of instructional strategies.
Evidence: ( Briefly document evidence, if any, that supports this area)
Teacher’s reflection is a generally accurate impression of a lesson’s effectiveness, the degree to which outcomes were met and/or makes general suggestions about how a lesson could be improved.
Teacher’s reflection accurately assesses the lesson’s effectiveness and the degree to which outcomes were met and can cite evidence to support the judgment; makes specific suggestions for lesson improvement.
Teacher’s reflection accurately, thoughtfully assesses the lesson’s effectiveness and the degree to which outcomes were met, citing specific examples; offers specific alternative actions drawing on an extensive repertoire of skills.
Evidence: ( Briefly document evidence, if any, that supports this area)
Domain Four: Professional Responsibilities
Component Target Level of Performance
Unsatisfactory Basic Proficient Distinguished
Teacher’s reflection does not accurately assess the lesson’s effectiveness or the degree to which outcomes were met and/or has no suggestions for how a lesson could be improved.
4b: Maintaining Accurate Records
4c: Communicating with Families
4d: Participating in a Professional Community
The information management system on student completion of assignments, student progress in learning and/or non-instructional activities is either absent or in disarray.
The information management system for student completion of assignments, progress in learning and/or non- instructional activities is rudimentary, and/or requires frequent monitoring for accuracy.
The information management system for student completion of assignments, student progress in learning and/or non-instructional activities is fully effective.
The information management system for student completion of assignments, progress in learning and/or non- instructional activities is fully effective, and students contribute to its maintenance and/or interpretation.
Professional relationships with colleagues are negative or self-serving; teacher avoids participation in a culture of inquiry and/or avoids becoming involved in school events and/or school and district projects.
Professional relationships are cordial and fulfill required school/district duties; include involvement in a culture of inquiry, school events and/or school/district projects when asked.
Professional relationships are characterized by mutual support and cooperation; include active participation in a culture of professional inquiry, job related school events and school/district projects, with teacher making substantial contributions.
Professional relationships are characterized by mutual support, cooperation and initiative in assuming leadership in promoting a culture of inquiry and making substantial contributions to school/district projects.
Evidence: ( Briefly document evidence, if any, that supports this area)
The educator provides little/no information to families about the instructional program and/or individual students; communication with families is insensitive or inappropriate to the culture of the families and/or makes no attempt to engage families in the instructional program.
The educator provides minimal and/or occasionally insensitive communication/respons es to family concerns; partially successful attempts to engage families in the instructional program.
The educator provides frequent, culturally- appropriate information to families about the instructional program, student progress, and responses to family concerns; frequent, successful efforts to engage families in the instructional program.
The educator provides frequent, culturally- appropriate information to families with student input; successful efforts to engage families in the instructional program to enhance student learning.
Evidence: ( Briefly document evidence, if any, that supports this area)
4e: Growing and Developing Professionally
4f: Showing Professionalism
D4 AVG:
Admin. insert
Domain Five: Student Data
Evidence: ( Briefly document evidence, if any, that supports this area)
Teachers professional interactions are characterized by questionable integrity, lack of awareness of student needs, and/or decisions that are selfserving, and/or do not comply with school/district regulations.
Teacher interactions are characterized by honest, genuine but inconsistent attempts to serve students, decisionmaking based on limited data, and/or minimal compliance with school/district regulations.
Teacher interactions are characterized by honesty, integrity, confidentiality and/or assurance that all students are fairly served, participation in team or departmental decision- making, and/or full compliance with school/district regulations.
Teacher interactions are characterized by the highest standards of honesty, integrity and confidentiality; assumption of leadership role with colleagues, in serving students, challenging negative attitudes/practices, and in ensuring full compliance with school/district regulations.
Evidence: ( Briefly document evidence, if any, that supports this area)
Professional relationships with colleagues are negative or self-serving; teacher avoids participation in a culture of inquiry and/or avoids becoming involved in school events and/or school and district projects.
Professional relationships are cordial and fulfill required school/district duties; include involvement in a culture of inquiry, school events and/or school/district projects when asked.
Professional relationships are characterized by mutual support and cooperation; include active participation in a culture of professional inquiry, job related school events and school/district projects, with teacher making substantial contributions.
Professional relationships are characterized by mutual support, cooperation and initiative in assuming leadership in promoting a culture of inquiry and making substantial contributions to school/district projects.
Evidence: ( Briefly document evidence, if any, that supports this area) Teacher engages in no professional development activities and/or resists feedback on teaching performance and/or makes no effort to share knowledge with others or to assume professional responsibilities. Teacher engages in professional activities to a limited extent and/or accepts with some reluctance feedback on teaching performance and/or finds limited ways to contribute to the profession. Teacher engages in seeking out professional development opportunities, welcomes feedback on performance and participates actively in assisting other educators.
Teacher engages in seeking out opportunities for professional development and makes a systematic effort to conduct action research, seeks out feedback and initiates important activities to contribute to the profession.
Overall Evaluation Score: Level: A discussion based on the teacher summative assessment took place. This form completes the summative assessment. The teacher’s signature represents that they received a copy and does not represent agreement. Teacher’s signature: Administrator’s signature: Date: