addon dual cover - simmons university · materials’that’go’to’supervisor’ 1....

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AddOn & Dual Licensure Practicum Handbook Simmons College Department of Education Initial License Practicum Handbook Dual Licensure Program Director of Clinical Programs: Helen Guttentag 2015 – 2016 Simmons College 300 The Fenway, C316 Boston, MA 02115 6175212553 All of the Candidate Assessment of Performance (CAP) forms are posted on the following link: http://internal.simmons.edu/students/ssw/foreducationstudents/formsandresources revised 10/20/15

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Page 1: AddON Dual Cover - Simmons University · Materials’that’go’to’Supervisor’ 1. Theaudio/visualsummary" 2. Lesson"Plans" 3. Documentationof100HoursofFullResponsibility" 4

Ad d -­‐ O n   &   D u a l   L i c e n s u r e   P r a c t i c um   H a n d b o o k  Simmons  College  Department  of  Education  

Initial  License  Practicum  Handbook  Dual  Licensure  Program  

Director  of  Clinical  Programs:  Helen  Guttentag  2015  –  2016  

 Simmons  College  

300  The  Fenway,  C316  Boston,  MA  02115  

 617-­‐521-­‐2553  

 

All  of  the  Candidate  Assessment  of  Performance  (CAP)  forms  are  posted  on  the  following  link:  

http://internal.simmons.edu/students/ssw/for-­‐education-­‐students/forms-­‐and-­‐resources  

 revised  10/20/15  

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Contact  Information    

Jane  Hardin:  Coordinator  of  the  SPED  Add  On  Program  617-­‐521-­‐2556  [email protected]    Helen  Guttentag:  Coordinator  of  the  Dual  Licensure  Program  617-­‐521-­‐2553  [email protected]    

Table  of  Contents  

Dual  License  General  Description                 3  

MTEL  Information                     3  

Endorsement  Procedure                   3  

Site  Approval                       3  

Seminars                       3  

SPED  Add  On  Practicum  Requirements               4  

Sources  of  Evidence                     5  

Positive  Behavior  Plan  Format                 6  

Guidelines  for  Reflection  on  IEP  Meetings               7  

Guidelines  for  Evaluating  the  Practicum               8  

Documentation  of  100  Hours  of  Full  Responsibility             12  

Documentation  of  Engagement  with  English  Language  Learners         13  

Lesson  Plan  Format  and  Template                 14  

Media  Consent  Form                     17  

Video/Audio  Recording  Form                   18  

Suggestions  for  SPED  Portfolio                 19  

Practicum  Confirmation  Form                 20  

Announced  ,  Unannounced,  and  Extra  Observation  Forms           21  

Candidate  Assessment  of  Performance  (CAP)             26  

Three-­‐Way  Meeting  Checklist                   34  

Pre-­‐Observation  Conference  Form                 36  

Post-­‐Observation  Conference  Form                 37  

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Student  Forms:  

-­‐ Self  Assessment                   39  

-­‐ Self  Reflection                     43  

-­‐ Preliminary  Goal  Setting                 44  

-­‐ Goals  and  Implementation  Plan               45  

-­‐ Model  Student  Feedback  Surveys               46  

 

All  of  the  Candidate  Assessment  of  Performance  (CAP)  forms  are  posted  on  the  following  link:  

http://internal.simmons.edu/students/ssw/for-­‐education-­‐students/forms-­‐and-­‐resources  

     

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THE  DUAL  LICENSURE  MAT  PROGRAM    Simmons  College  has  developed  a  graduate  program  leading  to  the  Master  of  Arts  in  Teaching  degree,  which  prepares  candidates  for  the  general  education  and  the  special  education  license.    Candidates  can  prepare  for  the  Elementary  license  and  the  Moderate  Special  Needs  PreK-­‐8  license,  or  a  secondary  license  and  the  Moderate  Special  Needs  5-­‐12  license.    This  is  a  46-­‐50  credit  program  consisting  of  course  work  in  general  and  special  education  and  a  year  long  classroom  internship.*    The  first  half  of  the  internship  fulfills  the  requirements  for  the  general  education  practicum  and  the  second  half  of  the  internship  fulfills  the  requirements  for  the  special  education  practicum.    Interns  remain  in  the  same  classroom  for  the  full  year,  and  the  classroom  must  have  two  or  more  learners  who  have  been  identified  as  having  special  needs.    Candidates  who  complete  this  program  will  be  eligible  for  a  general  classroom  teaching  position  or  a  position  as  a  special  education  teacher.    Teachers  with  dual  licensure  are  highly  sought  after  by  public  schools  and  will  be  strong  competitors  for  teaching  positions  in  the  growing  number  of  inclusive  classrooms.    *Simmons  Dunn  Scholars  may  be  able  to  complete  this  program  with  reduced  credits  at  the  graduate  level,  depending  on  their  undergraduate  programs.    Massachusetts  Tests  for  Educator  Licensure  (MTELs)  Elementary  and  SPED  Pre-­‐K  students  take  the  same  MTELs:     -­‐Communication  and  Literacy     -­‐General  Curriculum       -­‐Math  Subtest       -­‐Multi-­‐Subject  Subtest     -­‐Foundations  of  Reading    Secondary  students  take  the  following  MTELs:     -­‐Communication  and  Literacy     -­‐Subject  Matter  test  in  their  fields     -­‐Foundations  of  Reading      Endorsement  Procedure  Upon  completion  of  the  program  Simmons  will  endorse  the  candidate  for  the  general  license  in  the  candidate’s  field  and  level.  The  candidate  will  then  apply  on  his/her  own  to  add  on  the  Moderate  Special  Needs  license.    Site  Approval  The  intension  is  for  the  candidate  to  remain  in  the  same  classroom  for  both  practicums.    Thus,  it  is  important  to  confirm  ahead  of  time  that  the  placement  will  provide  the  opportunity  to  fulfill  the  requirements  for  both  practicums.    This  requires  the  school  administrator  to  complete  the  Practicum  Confirmation  Form  in  order  to  insure  that  the  candidate  will  have  sufficient  access  to  learners  with  special  needs.    (See  the  Simmons  Confirmation  Form  on  page  20)    Seminars  In  the  fall  candidates  will  attend  seminars  with  general  education  students  at  the  level  of  the  license  sought.  In  the  spring  candidates  will  attend  seminars  with  dual  licensure  students.      

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SPED  ADD  ON  PRACTICUM  REQUIREMENTS    The  SPED  Add  On  Practicum  was  originally  designed  for  fully  licensed  teachers  working  full  time  in  their  own  classrooms  and  using  their  classrooms  to  fulfill  the  requirements  for  the  special  education  practicum.    It  is  thus  assumed  that  candidates  in  the  special  education  practicum  will  be  doing  an  appropriate  amount  of  general  classroom  teaching  while  also  implementing  the  special  education  practicum  competencies.    The  degree  and  amount  of  teaching  should  be  determined  on  an  individual  basis  by  the  school  supervising  practitioner,  the  Simmons  supervisor,  and  the  candidate.    The  following  are  the  specific  requirements  for  the  special  education  practicum:      

1. Work  closely  with  classroom  teacher  and  serve  all  children.  2. Continue  to  send  weekly  journals  to  supervisors  3. Develop  and  teach  a  minimum  of  six  lessons.  

a. Use  lesson  plan  format  in  Handbook  (page  14)  and  on  line.  b. Submit  copies  to  Supervisor.  

4. Attend  at  least  one  IEP  meeting  and  write  a  reflection  on  the  meeting  (Handbook  page  7).  a. If  appropriate  the  intern  may  participate  in  the  IEP  process.  b. This  can  be  done  in  the  fall  during  the  elementary  practicum  if  the  opportunity  arises.  

5. For  the  seminar  interns  write  a  Philosophy  of  Education.    This  goes  to  the  seminar  leader  (Guidelines  given  in  seminar).  

6. The  Portfolio  from  the  fall  is  expanded  to  include  the  SPED  practicum  experience.  7. Documentation  of  the  following:  (All  forms  are  in  the  Handbook  and  on  line.)  

a. 100  hours  of  full  responsibility.  Instruction  must  include  learners  with  special  needs.  (page  12)  b. Log  of  Engagement  with  ELL  students  (page  13)  

8. Interns  need  to  obtain  a  copy  of  the  license  of  their  supervising  practitioner  and  give  it  to  their  supervisor.  If  the  supervising  practitioner  does  not  also  hold  a  moderate  special  needs  license,  the  Simmons  supervisor  needs  to  be  informed.  A  statement  from  the  appropriate  school  administrator  is  then  needed,  confirming  that  the  teacher  has  the  appropriate  skills  and  experience  to  fulfill  this  role.  This  statement  along  with  a  copy  of  the  teacher’s  resume  must  also  be  submitted  to  Helen  Guttentag  so  that  a  waiver  can  be  completed.  

9. Make  a  videotape  or  audiotape  of  one  lesson.  a. This  should  have  a  complete  lesson  plan  b. Student  must  obtain  consent  form  (Handbook  page  17)  c. The  student  views  the  tape  and  submits  a  reflection  and  critique  to  the  supervisor  Handbook  

(page  18).  d. If  the  supervising  practitioner  has  not  actually  observed  the  lesson,  he/she  should  view  the  

tape  and  discuss  with  the  intern.  10. One  Positive  Behavior  Plan    

a. If  the  fall  plan  was  in  an  academic  area,  the  spring  plan  must  be  in  a  behavioral  area.  b. If  the  fall  plan  was  in  a  behavioral  area,  the  spring  plan  must  be  in  an  academic  area.  

11. The  CAP  Form  must  be  completed  12. Three  3-­‐Way  Meetings  must  be  held.  

a. Attended  by  the  supervising  practitioner,  the  college  supervisor,  and  the  teaching  candidate  b. Students  should  take  notes  during  each  three-­‐way.  

         

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Materials  that  go  to  Supervisor  1. The  audio/visual  summary  2. Lesson  Plans  3. Documentation  of  100  Hours  of  Full  Responsibility  4. Documentation  of  hours  of  Engaging  with  ELL  students  5. The  CAP  Form  6. Additional  Forms  

a. Self  Assessment  Form  (at  the  start  of  the  practicum)  b. Self  Reflection  Form  (after  each  observed  lesson)  c. Preliminary  Goal  Setting  (toward  the  end  of  the  practicum)  d. Goals  and  Implementation  Plan  (at  the  end  of  the  practicum)  

 Supervisors  submit  the  above  forms  to  the  SPED  seminar  leader  at  the  end  of  the  semester  along  with  their  Observation  Forms.  Supervisors  make  three  announced  observations  during  the  semester.    Responsibilities  of  Supervising  Practitioner  

1. Minimum  of  two  formal  announced  observations  with  written  feedback  and  two  formal  unannounced  observations  with  written  feedback  (Handbook  page  21.)    

2. Provide  copy  of  license  number  to  Simmons  College  Supervisor  3. Provide  required  experiences  (IEPs;  student  assessments;  progress  reports;  inclusion  

experiences)  4. Weekly  oral  feedback  and  consultation  and  frequent  planning  sessions  5. Complete  the  CAP  Form  

a. Formative  Evaluation  at  the  halfway  point.  b. Summative  Evaluation  at  the  conclusion  of  the  practicum.  

6. Participate  in  three  3-­‐Way  meetings  with  the  college  supervisor  and  the  teacher  candidate.  7. Prior  to  each  announced  observation  hold  a  pre-­‐observation  conference  with  the  teacher  

candidate  (handbook  page  36)  8. After  each  formal  announced  and  unannounced  observation  hold  a  post  observation  conference  

with  the  teacher  candidate  (handbook  page  37)    Four  Sources  of  Evidence  for  the  CAP  

1. Observations  by  the  supervising  practitioner  and  college  supervisor  (written  notes  during  observations)  

2. Impact/Measure  of  Student  Learning  (Contained  in  Evaluation  section  of  every  lesson  plan)  3. Student  Feedback  Surveys  

a. Administered  half-­‐way  through  the  practicum  b. Geared  to  different  levels  (PrK-­‐2;  3-­‐5;  6-­‐12)  

4. Artifacts  a. Lesson  Plans  b. Curriculum  Units  c. Curriculum  Materials  d. Sample  Student  Work  e. Rubrics  f. Quizzes/Tests  g. Video/Audio  Recordings  h. Behavior  Plans  and  Behavior  Data  

   

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Positive  Behavior  Plan  

 1. Learner  Description:  

a. First  name  and  age  b. Grade  c. Previous  special  services  and/or  grade  repetitions  if  any  

 2. Educational  Setting:  

a. Classroom  size  and  population  b. Classroom  structure/organization  

 3. Target:  Specific  Observable  Behavior  

 4. Entry  Level  or  Baseline  Data:  

a. Procedure  used  in  obtaining  baseline/  entry  level  b. Current  level  of  skill  or  behavior  

 5. Goals:  

a. Social  1) Reasonable  reduction  of  non  productive  behavior  2) Replacement  with  positive  alternative  

b. Academic  1) Realistic  goals  for  development  of  skills  2) Sequence  of  skills  paired  with  time  of  attainment  

 6. Development  of  Plan:  

a. Consider  causes  of  behavior  or  academic  challenge  b. Identify  on  how  to  build  on  student’s  strengths  c. Consider  use  of  effective  reinforcers  and  eventual  thinning  of  reinforcers  d. Specific  teaching  steps  

 7. System  of  Measuring  and  Recording  Progress:  

a. Daily  data    b. Graphs  of  data  (optional)  c. Consider  self  monitoring  and  recording  of  data  

 8. Results:  

a. Number  of  sessions  and  length  of  program  (beginning  and  ending  dates)  b. Goals  mastered  c. Data  that  demonstrates  progress  

 9. Discussion:  

a. Evaluation  of  student’s  progress  and  effectiveness  of  program  b. Recommendations  

     

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GUIDELINES  FOR  REFLECTION  ON  IEP  MEETING  

1. Who  attended  the  meeting  (roles,  not  names)?  

 

 

2. Did  the  meeting  flow  smoothly  or  were  there  points  of  contention?  

 

 

 

3. From  your  observation,  did  the  team  reach  agreement?  

 

 

 

4. How  did  the  team  leader  wrap  up  the  meeting?  

 

 

 

5. Any  other  comments  or  impressions.  

 

     

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Guidelines  for  Evaluating  the  Practicum    Practicum  Rubric  (adapted  from:  www.hopton.ca/Practicum%20Rubric_ED2_2006.pdf)  

Responsibility   Does  not  meet  the  Standard  

At  Risk   Meets  the  Standard  

Exceeds  the  Standard  

Lesson  Planning   Incomplete/Disorganized,  Plans  are  uninspired,  Provides  little  variety  in  teaching/learning  strategies  selected  

Incomplete,  expectations  unclear,  Plans  reflect  little  originality  or  creativity  

Complete  and  Organized,  Includes  some  original  elements  in  plans,  Varies  strategies  in  most  lessons  

Plans  are  logically  organized,  identifies  imaginative  and  creative  teaching  approaches  

Learning  Materials   Materials  are  disorganized  and  not  readily  accessible  to  students,  Fails  to  locate  relevant  learning  resources  

Materials  are  somewhat  organized,  Has  difficulty  choosing  relevant  learning  resources  

Chooses  age  appropriate  &  relevant  resources,  Materials  reflect  attention  to  students’  interests  and  differences  

Chooses  a  variety  of  innovative  resources,  materials  are  organized  to  promote  students’  responsibility  

Implementing  Lesson   Fails  to  use  effective  introductions  to  lessons,  Students  remain  passive  and  uninvolved,  Lessons  drag  

Designs  weak  introductions,  Students  moderately  involved,  Pacing  is  too  fast  or  too  slow  

Uses  a  limited  range  of  strategies  to  engage  learners,  Promotes  good  student  involvement,  Pacing  and  timing  are  acceptable  

Introduces  lessons  using  a  range  of  strategies  that  meet  student  needs,  Lesson  ends  with  opportunity  to  extend  learning,  Uses  initiative  to  adjust  pacing  and  time  appropriately      

Teaching  Strategies   Fails  to  differentiate  instruction  

Beginning  to  use  instructional  time  purposefully,  Learning  to  differentiate  instruction  

Uses  instructional  time  purposefully  most  of  the  time,  Differentiates  instruction  to  meet  students’    needs  

Strategies  promote  student  ownership  of  learning,  Differentiates  instruction  to  meet  all  student’s  needs  

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Responsibility   Does  not  meet  the  Standard  

At  Risk   Meets  the  Standard  

Exceeds  the  Standard  

Student  Interactions/Development  

Demonstrates  difficulty  in  maintaining  positive  interactions  with  students,  Demonstrates  limited  rapport  with  students  

Beginning  to  maintain  positive  interactions  with  students,  Demonstrates  effective  rapport  with  students  

Maintains  positive  interactions  with  students  most  of  the  time,  Demonstrates  effective  rapport  with  students  most  of  the  time  

Maintains  positive  interactions  with  students  consistently,  Demonstrates  effective  rapport  with  students  in  a  variety  of  settings  consistently  

Oral  Communication   Communicates  with  inappropriate  level  of  vocabulary,  Speech  is  very  hesitant  or  rapid;  monotonous  or  harsh,  Directions  are  unclear  and  inaccurate  

Demonstrates  some  difficulty  in  communication  with  errors  in  form  and  structure,  Speech  is  often  too  hesitant  or  rapid,  Directions  are  occasionally  clear  

Communicates  well  with  adequate  levels  of  vocabulary,  Speech  is  pleasant  and  natural,  Directions  are  clear  and  accurate  

Communicates  effectively,  Uses  animated  voice  that  is  well-­‐modulated  and  projects  well,  Directions  are  consistently  clear  and  accurate  

Classroom  Management   Fails  to  maintain  routines,  Students  off-­‐task,  Demonstrates  difficulty  in  setting  behavior  standards,  Fails  to  involve  students  in  learning,  Demonstrates  inability  to  anticipate  problems  

Maintains  somewhat  negative  tones  in  classroom,  Some  students  are  on  task,  Sets  inconsistent  behavior  standards,  Anticipate  some  problems  

Maintains  positive  tone  in  classroom,  Most  students  are  on  task,  Maintains  consistent  behavior  standards,  Anticipates  problems  and  plans  to  avoid  situations  

Maintains  high  class  morale  with  clearly  defined  roles,  All  students  are  on  task  and  focused,  Uses  appropriate  consequences  for  behavior  consistently,  Acts  proactively  to  manage  behavior  and  anticipate  problems.        

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Responsibility   Does  not  meet  the  Standard  

At  Risk   Meets  the  Standard  

Exceeds  the  Standard  

Student  Learning   Demonstrates  difficulty  addressing  student  needs,  Fails  to  encourage  student  participation  

Beginning  to  consider  student  needs,  Provides  limited  student  participation  

Considers  student  needs  most  of  the  time,  Provides  for  regular  student  participation  

Considers  student  needs  consistently,  Provides  for  consistent  meaningful  student  participation  

Quantifiable  Assessment     Demonstrates  problems  in  aligning  assessment  strategies  to  expectations,  Demonstrates  difficulty  in  identifying  appropriate  evaluation  criteria  

Relies  on  limited  range  of  quantifiable  assessment  strategies,  Learning  to  identify  evaluation  criteria  

Utilizes  comprehensive  range  of  quantifiable  assessment  strategies,  Aligns  assessment  with  expectations  

Collects  formative,  quantifiable  assessment  data  on  an  ongoing  basis,  Aligns  assessment  with  expectations  consistently  

Collaboration,  Professionalism  

Demonstrates  marked  difficulty  in  relating  to  others,  Rarely  collaborates,  Demonstrates  difficulty  in  meeting  deadlines  

Demonstrates  difficulty  in  relating  to  others,  Sometimes  collaborates  with  others,  Meets  most  deadlines  

Relates  to  others,  Collaborates  with  others  regularly,  Meets  all  deadlines  

Relates  extremely  well  to  others,  Takes  initiative  to  work  collaboratively  with  others,  Meets  all  deadlines  confidently  

Attendance   Has  missed  an  excessive  number  of  practicum  days  

Attends  most  practicum  days,  Inconsistently  informs  supervisor  or  SP  

Has  missed  few  practicum  days  Contacts  supervisor  and  SP  regarding  missed  days  

Has  missed  very  few  practicum  days,  is  consistently  punctual,  contacts  supervisor  and  SP  regarding  absences  

Personal  Qualities   Lacks  confidence  or  is  overly  confident  

Sometimes  lacks  confidence  or  is  overly  confident  

Acts  as  a  pleasant,  dependable  and  conscientious  member  of  staff  most  of  the  time    

Consistently  demonstrates  cooperation,  enthusiasm  and  initiative  

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Responsibility   Does  not  meet  the  Standard  

At  Risk   Meets  the  Standard  

Exceeds  the  Standard  

Continuous  Improvement   Demonstrates  difficulty  in  indentifying  best  practice,  Demonstrates  difficulty  in  assessing  personal  progress  

Learning  to  identify  best  practice  with  support,  Learning  to  assess  personal  strengths  with  support  

Identifies  best  practice  independently,  Sets  personal  goals  independently  

Aligns  personal  growth  goals  with  knowledge  of  best  practice,  Sets  and  meets  personal  and  professional  goals  consistently      

Reflective  Practice   Demonstrates  difficulty  in  accepting  constructive  feedback  

Learning  to  accept  constructive  feedback  

Accepts  constructive  feedback  willingly  and  implements  it  most  of  the  time  

Uses  and  implements  constructive  feedback  to  improve  practice  

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DOCUMENTATION  OF  100  HOURS  OF  FULL  RESPONSIBILITY  Full  responsibility  is  defined  in  the  following  way:  The   intern   plans   and   teaches   a   lesson   taking   full   responsibility   for   instruction   and   classroom  

management.    The  supervising  practitioner  may  be  in  the  room,  but  does  not  intervene  in  the  lesson.    Lessons  may  be  one-­‐on-­‐one,  small  group,  or  whole  class  format.    Full  responsibility  extends  to  supervisory  activities  as  well   such   as   overseeing   transitions,   recess,   or   other   activities   where   the   intern   is   fully   in   charge   and  responsible  for  the  students,  class  and  instruction.  

 Time     Date   Description  of  Activity        

       

       

       

       

       

       

       

       

       

       

       

 Total  Hours      Use  additional  pages  as  needed.  The  total  number  of  logged  hours  must  be  equal  to  or  exceed  the  number  of  hours  required  for  the  license  sought.        Student’s  Signature:_________________________________________________________    Date:  __________  

 Supervising  Practitioner’s  Signature:____________________________________________    Date:  __________  

 Students  please  keep  a  copy  for  your  records  

   

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DOCUMENTATION  OF  ENGAGEMENT  WITH  ENGLISH  LANGUAGE  LEARNERS  

An   English   Language   Learner   (ELL)   is   a   student   whose   first   language   in   not   English.     World-­‐class  Instruction   and   Design   and   Assessment   (WIDA)   defines   English   language   learners   as   “linguistically   and  culturally   diverse   students   who   have   been   identified   as   having   levels   of   English   language   proficiency   that  require  language  support  to  achieve  grade-­‐level  content  in  English  (http://www.wida.us/standards/eld.aspx).    In  addition,  an  ELL  can  be  described  as  a  student  whose  English  language  environment  needs  to  be  sheltered  in  order  for  him/her  to  be  successful  academically.  Sheltered  English  Instruction  may  be  defined  by  information  at:  http://www.alliance.brown.edu/tdl/tl-strategies/mc-principles.shtml.

Engagement   with   English   Language   Learns   can   be   describe   as,   but   not   limited   to   the   following  activities:     Creating   instructional   materials   that   support   students   with   diverse   cultural   and   linguistic  backgrounds;  using  appropriately  designed  visual  and  contextual  aides  when  communicating  with  ELLS;  using  effective   strategies   and   techniques   for   making   content   accessible   to   ELLs;   differentiating   instruction   to  accommodate   learners  who   are   at   various   levels   of   English   language   proficiency   and   literacy;   collaborating  with  families  to  create  strategies  for  supporting  student  learning  both  at  home  and  at  school.  

Interns  must  document  a  minimum  of  15  hours  of  engagement  with  ELLs  as  part  of  the  pre-­‐practicum  or  practicum  experience  

 Time     Date   Description  of  Activity        

       

       

       

       

       

       

       

       

 Total  Hours  this  

Page      

Use  additional  pages  as  needed.  Student’s  Signature:_________________________________________________________    Date:  __________  

 Supervising  Practitioner’s  Signature:____________________________________________    Date:  __________  

 Students  please  keep  a  copy  for  your  records  

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Simmons  College  Programs  in  Special  Education  

Lesson  Plan  Format  (Moderate,  Severe)  

Practicum  Student:               Date:                                                                                  Subject/Skills  _____________Grade  Level:          Number  of  Learner(s):      Time  of  Lesson  (Period)____________________________  Length  of  Lesson  _______________  Curriculum  Frameworks  (use  only  Common  Core)  that  would  be  taught  to  same  age  non-­‐disabled  peers)  Grade  Level  __________:    Subject  _________________Strand:  _______________________________  Standard:  ______________________________Page  Number___________  Publication  Date  _______    1. Purpose/Objective/Function  a. Identify  the  purpose  of  the  lesson  b. Identify  how  this  lesson  is  linked  to  a  sequential  unit  of  study    2. Pre-­‐requisite  skills/knowledge  a. Identify  any  pre-­‐requisite  skills  or  abilities  necessary  for  this  lesson  b. Identify  how  formal  and  informal  assessments  have  informed  decisions  in  determining  what  and  how  to  teach  to  

individual  students  3. Schedule  and  Pacing  a. Outline  and  sequence  the  lesson  in  the  proposed  order  that  it  will  be  taught  (an  agenda)      b. Include  the  approximate  pacing  of  each  step  4. Materials  a. List  materials  used  in  the  lesson  5. IEP  Goals/Objectives/Benchmarks  -­‐    (minimum  2  per  lesson  plan)  a. Record  the  IEP  goals/objectives/benchmarks,  verbatim,  to  be  addressed  within  the  lesson    b. In  addition,  rewrite  objectives  goals/objectives/benchmarks  as  observable  and  measureable  (when  necessary)  c. Identify  how  these  IEP  objectives  or  benchmarks  inform  instruction,  selection  of  materials  or  selection  of  

approaches  6. Specially  –  Designed  Instruction  a. Identify  specially  designed  instruction  (content,  methodology,  and/or  performance  criteria)  necessary  to  help  

individual  students  learn  the  academic  content  b. Identify  any  assistive  technology  that  will  be  used  to  help  individual  students  learn  and  access  the  academic  

content  c. Identify  any  behavioral  intervention  strategies  to  help  individual  students  learn  and  access  the  academic  content.  7. Accommodations/Adaptations  a. Identify  accommodations  necessary  to  help  individual  students  better  access  the  curriculum  8. Possible  Problems  and  Solutions  a. Brainstorm  possible  problems  with  the  lesson/learners  b. For  each  possible  problem,  write  a  theoretical  solution  in  advance  of  the  lesson  9. Lesson  Closure  a. Identify  the  process  and  procedure  for  closure  of  the  lesson  10. Assessment    a. Identify  assessment  tool,  process  or  procedure  b. Specify  anticipated  achievements  in  qualitative  or  quantitative  terms  c. Assessment  linked  to  the  purpose  of  the  lesson  11. Extension  of  the  Lesson  a. Identify  how  the  lesson  will  be  extended  through  activities  such  as:  Homework,  Assignments,  Follow-­‐up  activities,  

Future  lesson,  etc.  

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Lesson: _____________________________________ Date: ___________________ General Goal: Objective/Function:

MA Frameworks/Common Core Standards: Materials (include any assistive technology):

Specially Designed Instruction (taken from the IEP)

Connection (to previous lessons and/or other content areas):

Accommodations and/or Adaptations:

Possible Problems and Solutions (Brainstorm possible problems and write a theoretical solution in advance of the lesson):

Scheduling and Pacing of the Lesson (include an agenda and approximate pacing of each step): Intro- How will you engage the students?

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Scheduling and Pacing of the Lesson (include an agenda and approximate pacing of each step): Lesson Closure-How will you wrap up this lesson?

I.E.P. Goals/Objectives/Benchmarks (minimum of 2 for each lesson) (Include IEP goals as written but when necessary, rewrite the goals/objectives/benchmarks as observable and measureable. The rewritten goals should be in parenthesis.):

Differentiation (think about learners of various levels and ELLs):

Assessment: How is your assessment linked to the purpose of this lesson? Identify assessment tool, process or procedure ( e.g. a quiz, exit ticket, data collection in discrete trial, etc.)

Extension of the Lesson:

Reflection:

Plan for Subsequent Lessons:

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Simmons  College  Programs  in  Special  Education  

Media  Consent  Form  (to  be  used  in  the  absence  of  a  site-­‐based  consent  form)  

   I  have  been  informed  that  sound  recordings  and/or  videotape  footage  of  my  child  may  be  used  as  part  of  a  training  module  for  teachers  serving  learners  with  disabilities.    I  understand  that  my  child’s  name  will  not  be  used  or  any  other  information  that  may  identify  my  child.    I  understand  that  the  videotape  will  be  used  for  instructional  purposes  only,  and  the  Department  and  the  student  will  not  release  the  videotape  to  the  public.    The  tape  will  be  erased  by  the  student  at  the  conclusion  of  the  assignment.      

 

Name  of  Learner:          

 

Signature  of  Parent/Guardian:         Date:    

(Student,  if  over  18)    School  Name:        

 

Street  Address:        

   

Town:                                                          State:_________________                                                            Zip:      

 

School  Telephone:        

   Name  of  Supervising  Practitioner:                Signature  of  Supervising  Practitioner:         Date:    

         

       

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Video/Audio  Recording  Form  Attach  this  form  to  your  typed  self-­‐reflection  document  along  with  the  formal  lesson  plan.  

   Date  of  Recording:______________    Topic  of  Lesson:___________________________  Length  of  the  Recording:  ______________________    Examples  of  concepts  to  reflect  upon  for  the  recording  summary:    

• Curriculum  Frameworks  Addressed  • How  you  began  the  lesson  in  an  engaging  manner  • An  agenda  was  posted  and  referred  to,  and  the  steps  that  were  to  occur  in  the  lesson  were  explicitly  

identified  • How  male  and  female  students  were  called    upon  equally  • Strategies  that  were  used  to  engage  reluctant  learners  • Specialized  instruction  that  was  employed  to  help  achieve  the  goals  of  the  lesson  for  learners  on  IEPs  • Strategies  that  were  employed  to  improve  behavior  of  the  class.    Strategies  that  were  employed  to  

maintain  the  flow  of  instruction  • Teaching  skills  relative  to  the  license  sought  • What  part(s)  of  the  lesson  might  you  do  in  a  different  (same)  manner?  • What  do  you  feel  went  especially  well?    On  what  do  you  base  that?  • When  you  reviewed  the  recording,  what  surprised  you  most  about  your  instruction/teaching  style,  or  

presentation?    We  verify  that  all  necessary  consent  was  obtained  for  students  prior  to  the  recording  of  this  lesson.    ______________________________  ___________________________________  Intern  signature         Supervising  Practitioner  signature      I  have  reviewed  the  recording  and  offer  the  following  comments,  suggestions:      

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Suggestions  for  Your  Special  Education  Portfolio  

1. NO  IEP’s  in  the  portfolio  –  no  removing  names,  etc.  These  documents  are  VERY  confidential.  You  may  however,  use  a   fictitious   IEP   that  you  might  have  written   for  a  previous  Simmons  class.   If   this   is   the  case,  you  MUST  add  a  notation  somewhere  on  the  page  explaining  this.  

2. Attendance  to  an   IEP  meeting  –  remember  to  white  out  and/or  delete  student  names,  date  of  birth,  parents/family  names,  etc.  Black  marker  does  not  work.  

3. Copy  of  a  page  of  an  assessment,  management  guidelines,  etc.  –  proof  read  again  that  all  names  have  been  deleted  and/or  use  white  out.   Sometimes   the  name  also   appears   in   the   footer   along  with   the  path  on  the  network—delete  this  too.  

4. Explanatory   notes   –   anywhere   that   you   can   explain   a   document   in   your   portfolio   helps   the   viewer.  Each  item  should  have  an  explanatory  note.    

 

Highly  Recommended!  

Each  section  of   the  portfolio  must  be   specifically  defined  with   tabs.  Each  piece  of  evidence  must  be  clearly  labeled  and/or  an  explanation  of  what  the  reader  is  observing  should  be  included  on  the  page.  

1. Table  of  contents  2. Current  Resume  3. Philosophy  of  Education  4. Letters  of  Recommendation  5. Licensure:  For  now,  include  your  MTEL  scores  to  show  that  you  are  eligible  for  licensure.  Later,  replace  

this  with  a  copy  of  your  license.  6. Several  samples  of  your  lesson  plans.  The  plans  should  clearly  show  how  you  have  modified  or  adapted  

instruction  to  meet  the  needs  of  the  learners  with  special  needs.  7. Examples  of  behavior  management  strategies  you  have  used  or  tried.  8. How  you  developed  and  implemented  classroom  rules.    9. Attendance  at  IEP  meetings.  10. Participation  in  Parent/Teacher  conferences.    

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SIMMONS  COLLEGE  PRACTICUM  CONFIRMATION  FORM  DUAL  LICENSURE  PROGRAM  

   Dual  Licensure  Intern:  ________________________________________________  Licensure  Program:  (check  one)     □  Teacher  of  Students  with  Moderate  Disabilities,  Pre  K  –  8     □  Teacher  of  Students  with  Moderate  Disabilities,  5  –  12    Supervising  Practitioner:  ________________________________________________      The   above   named   student   will   be   doing   a   year   long   internship   at   your   school   with   the   above   named  supervising  practitioner.  During  the  first  half  of  the  year  the  student  will  be  fulfilling  the  requirements  for  the  General  Education  practicum   in  his/her   field  and   level.  During  the  second  half  of   the   internship  the  student  will  be  fulfilling  the  requirements  for  the  Moderate  Special  Needs  practicum.      To   insure  that  students  will  have  sufficient  access   to   learners  with  moderate  special  needs  so  that   they  can  have   an   adequate   amount   of   time   spent   in   direct   contact   with   these   learners,   please   confirm   that   the  following  conditions  will  be  met:      

1. The  Dual  Licensure  Intern  will  have  access  to  a  minimum  of  three  or  more  students  with  special  needs  at  the  level  of  the  license  sought.    

2. The  Supervising  Practitioner  holds  a  Moderate  Special  Needs  License  or  can  be  recommended  by  the  school  principal  or  department  chair  as  having  the  skills  and  experience  to  serve  in  this  role.  

3. The  Supervising  Practitioner  understands  his/her  role  and  responsibilities  and  can  provide  the  support  necessary  for  the  practicum  experience.    

     Name  of  Administrator:  _______________________________________________   Role  and  Title:  _______________________________________________________    Signature  of  Administrator:  _____________________________________________    Date:  _______________________________________________________________  

 

 

20

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    Candidate  Assessment  of  Performance  (CAP):  Observation  Forms        

   

 Observation  Form  

Pre-­‐Observation  Conference  

Observation  Details    

Date:     Time  (start/end):      

Content  Topic/Lesson  Objective:    

   

Whole  Group      

Small  Group      

One-­‐on-­‐One      

Other    

Active  Evidence  Collection  occurred  during  the  observation  and  is  synthesized  and  categorized  below.    Element   Evidence  

1.A.4    

1.B.2    

2.A.3    

2.B.1    

2.D.2    

4.A.1    

 

Focused  Feedback  

Reinforcement  Area/Action:  (strengths)  

 

Refinement  Area/Action:  (areas  for  improvement)    

Supervising  Practitioner                                                                                                                                                                                                        Date:                              

Program  Supervisor                                                                                                                              Date:  

   

What:     How:    

Who:    

Focus  Elements:      

Focus  Elements:      

21

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    Candidate  Assessment  of  Performance  (CAP):  Observation  Forms        

   

CAP  Observation  Form:  Announced  Observation  #1  

Pre-­‐Observation  Conference    Observation  Details    

Date:     Time  (start/end):      

Content  Topic/Lesson  Objective:    

   

Whole  Group      

Small  Group      

One-­‐on-­‐One      

Other    

Active  Evidence  Collection  occurred  during  the  observation  and  is  synthesized  and  categorized  below.    Element*   Evidence**    

1.A.4*    

1.B.2    

2.A.3    

2.B.1    

2.D.2*    

4.A.1    

 

Focused  Feedback  

Reinforcement  Area/Action:  (strengths)  

 

Refinement  Area/Action:  (areas  for  improvement)    

Supervising  Practitioner                                                                                                                                                                                                        Date:                              

Program  Supervisor                                                                                                                              Date:  

 

What:   Observation  #  1   How:   Announced  

Who:   Program  Supervisor  &  Supervising  Practitioner  

Focus  Elements:    1.A.4  Well-­‐Structured  Lessons;  2.D.2  High  Expectations    

Note:  As  this  is  the  first  observation,  assessors  should  attempt  to  collect  evidence  for  all  elements  in  order  to  provide  a  baseline  for  future  observations  

22

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    Candidate  Assessment  of  Performance  (CAP):  Observation  Forms        

 

CAP  Observation  Form:    Unannounced  Observation  #1  

What:   Observation  #  1   How:   Unannounced  

Who:   Supervising  Practitioner  

Focus  Elements:     1.A.4:  Well  Structured  Lessons;  2.B.1:  Safe  Learning  Environment  

 Observation  Details    

Date:     Time  (start/end):      

Content  Topic/Lesson  Objective:    

   

Whole  Group      

Small  Group      

One-­‐on-­‐One      

Other    

Active  Evidence  Collection  occurred  during  the  observation  and  is  synthesized  and  categorized  below.    

Element*   Evidence**    

1.A.4*    

1.B.2    

2.A.3    

2.B.1*    

2.D.2    

4.A.1    

 

Focused  Feedback  

Reinforcement  Area/Action:  (strengths)  

 

Refinement  Area/Action:  (areas  for  improvement)  

     

Supervising  Practitioner                                                                                                                                                                                                      Date:                              

 

23

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    Candidate  Assessment  of  Performance  (CAP):  Observation  Forms        

   

CAP  Observation  Form:    Announced  Observation  #2  

What:   Observation  #  2   How:   Announced  

Who:   Program  Supervisor    

Focus  Elements:     1.B.2:  Adjustments  to  Practice;  2.A.3:  Meeting  Diverse  Needs  

 

Pre-­‐Observation  Conference    Observation  Details    

Date:     Time  (start/end):      

Content  Topic/Lesson  Objective:    

   

Whole  Group      

Small  Group      

One-­‐on-­‐One      

Other    

Active  Evidence  Collection  occurred  during  the  observation  and  is  synthesized  and  categorized  below.    Element*   Evidence**    

1.A.4    

1.B.2*    

2.A.3*    

2.B.1    

2.D.2    

4.A.1    

 

Focused  Feedback  

Reinforcement  Area/Action:  (strengths)  

 

Refinement  Area/Action:  (areas  for  improvement)    

Supervising  Practitioner                                                                                                                                                                                                        Date:                              

Program  Supervisor                                                                                                                              Date:  

 

24

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    Candidate  Assessment  of  Performance  (CAP):  Observation  Forms        

Observation  Form:    Unannounced  Observation  #2  

What:   Observation  #  2   How:   Unannounced  

Who:   Supervising  Practitioner  &  Program  Supervisor  

Focus  Elements:     1.B.2:  Adjustment  to  Practice  &  Others  as  identified  during  the  Formative  Assessment  

 Observation  Details    

Date:     Time  (start/end):      

Content  Topic/Lesson  Objective:    

   

Whole  Group      

Small  Group      

One-­‐on-­‐One      

Other    

Active  Evidence  Collection  occurred  during  the  observation  and  is  synthesized  and  categorized  below.    

Element*   Evidence**    

1.A.4    

1.B.2*    

2.A.3    

2.B.1    

2.D.2    

4.A.1    

 

Focused  Feedback  

Reinforcement  Area/Action:  (strengths)  

 

Refinement  Area/Action:  (areas  for  improvement)    

Supervising  Practitioner                                                                                                                                                                                                      Date:                              

Program  Supervisor     (Optional)                                                                                                                                                                Date:  

 25

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Candidate  Assessment  of  Performance  (CAP)  Form  &  Rubric                                                                                                          1  

 

Candidate  Assessment  of  Performance  Form  and  Rubric  

Section  1:  General  Information  (to  be  completed  by  the  Candidate)  Candidate  Information  

First  Name:     Last  Name:    

Street  Address:    

City/Town:     State:     Zip:    

MEPID  #:    

Massachusetts  license  number(if  applicable):    

Program  Information  

Sponsoring  Organization:    

Program  Area  &  Grade  Level:    

Have  any  components  of  the  approved  program  been  waived?        603  CMR  7.03(1)(b)    

 

   

Yes                        No  

Practicum  Information    

Practicum    

Practicum  Equivalent    

Practicum/Equivalent  Course  Number:     Credit  hours:    

Practicum/Equivalent  Seminar  Course  Title:    

Practicum/Equivalent  Site:     Grade  Level(s)  of  Students:    

Total  Number  of  Practicum  Hours:    Number  of  hours  assumed  full  responsibility  in  the  role:    

Supervising  Practitioner  Information  (to  be  completed  by  the  Program  Supervisor)  

Name:      

School  District:     Position:    

License  Field(s):    MEPID  or  License  #    

#  of  years  experience  under  license:      

Initial    

Professional    

To  the  best  of  my  knowledge  (per  the  Supervising  Practitioner’s  Principal/Evaluator),  the  Supervising  Practitioner  has  received  a  summative  evaluation  rating  of  proficient  or  higher  in  his  most  recent  evaluation.        

 

Yes    

No    

 

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Candidate  Assessment  of  Performance  (CAP)  Form  &  Rubric                                                                                                          2  

Section  2:  CAP  Rubric  (to  be  completed  by  the  Program  Supervisor  and  Supervising  Practitioner  )  I.A.4:  Well-­‐Structure  Lessons  

I-­‐A-­‐4.  Well-­‐Structured  Lessons  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Develops  lessons  with  inappropriate  student  engagement  strategies,  pacing,  sequence,  activities,  materials,  resources,  and/or  grouping  for  the  intended  outcome  or  for  the  students  in  the  class.  

Develops  lessons  with  only  some  elements  of  appropriate  student  engagement  strategies,  pacing,  sequence,  activities,  materials,  resources,  and  grouping.  

Develops  well-­‐structured  lessons  with  challenging,  measurable  objectives  and  appropriate  student  engagement  strategies,  pacing,  sequence,  activities,  materials,  resources,  technologies,  and  grouping.  

Develops  well-­‐structured  and  highly  engaging  lessons  with  challenging,  measurable  objectives  and  appropriate  student  engagement  strategies,  pacing,  sequence,  activities,  materials,  resources,  technologies,  and  grouping  to  attend  to  every  student’s  needs.  Is  able  to  model  this  element.  

   Formative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

 Summative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

     

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Candidate  Assessment  of  Performance  (CAP)  Form  &  Rubric                                                                                                          3  

I.B.2:  Adjustment  to  Practice  

I-­‐B-­‐2.  Adjustment  to  Practice  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Makes  few  adjustments  to  practice  based  on  formal  and  informal  assessments.    

May  organize  and  analyze  some  assessment  results  but  only  occasionally  adjusts  practice  or  modifies  future  instruction  based  on  the  findings.    

Organizes  and  analyzes  results  from  a  variety  of  assessments  to  determine  progress  toward  intended  outcomes  and  uses  these  findings  to  adjust  practice  and  identify  and/or  implement  appropriate  differentiated  interventions  and  enhancements  for  students.    

Organizes  and  analyzes  results  from  a  comprehensive  system  of  assessments  to  determine  progress  toward  intended  outcomes  and  frequently  uses  these  findings  to  adjust  practice  and  identify  and/or  implement  appropriate  differentiated  interventions  and  enhancements  for  individuals  and  groups  of  students  and  appropriate  modifications  of  lessons  and  units.  Is  able  to  model  this  element.  

   Formative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

 Summative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

     

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Candidate  Assessment  of  Performance  (CAP)  Form  &  Rubric                                                                                                          4  

II.A.3:  Meeting  Diverse  Needs  

II-­‐A-­‐3.  Meeting  Diverse  Needs  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Uses  limited  and/or  inappropriate  practices  to  accommodate  differences.  

May  use  some  appropriate  practices  to  accommodate  differences,  but  fails  to  address  an  adequate  range  of  differences.    

Uses  appropriate  practices,  including  tiered  instruction  and  scaffolds,  to  accommodate  differences  in  learning  styles,  needs,  interests,  and  levels  of  readiness,  including  those  of  students  with  disabilities  and  English  learners.  

Uses  a  varied  repertoire  of  practices  to  create  structured  opportunities  for  each  student  to  meet  or  exceed  state  standards/local  curriculum  and  behavioral  expectations.  Is  able  to  model  this  element.  

   Formative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

 Summative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

   

   

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Candidate  Assessment  of  Performance  (CAP)  Form  &  Rubric                                                                                                          5  

II.B.1:    Safe  Learning  Environment    

II-­‐B-­‐1.  Safe  Learning  Environment  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  

Maintains  a  physical  environment  that  is  unsafe  or  does  not  support  student  learning.  Uses  inappropriate  or  ineffective  rituals,  routines,  and/or  responses  to  reinforce  positive  behavior  or  respond  to  behaviors  that  interfere  with  students’  learning.  

May  create  and  maintain  a  safe  physical  environment  but  inconsistently  maintains  rituals,  routines,  and  responses  needed  to  prevent  and/or  stop  behaviors  that  interfere  with  all  students’  learning.  

Uses  rituals,  routines,  and  appropriate  responses  that  create  and  maintain  a  safe  physical  and  intellectual  environment  where  students  take  academic  risks  and  most  behaviors  that  interfere  with  learning  are  prevented.    

Uses  rituals,  routines,  and  proactive  responses  that  create  and  maintain  a  safe  physical  and  intellectual  environment  where  students  take  academic  risks  and  play  an  active  role—individually  and  collectively—in  preventing  behaviors  that  interfere  with  learning.  Is  able  to  model  this  element.  

 Formative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

 Summative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

     

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Candidate  Assessment  of  Performance  (CAP)  Form  &  Rubric                                                                                                          6  

II.D.2:    High  Expectations      

II-­‐D-­‐2.  High  Expectations  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  

Gives  up  on  some  students  or  communicates  that  some  cannot  master  challenging  material.  

May  tell  students  that  the  subject  or  assignment  is  challenging  and  that  they  need  to  work  hard  but  does  little  to  counteract  student  misconceptions  about  innate  ability.    

Effectively  models  and  reinforces  ways  that  students  can  master  challenging  material  through  effective  effort,  rather  than  having  to  depend  on  innate  ability.  

Effectively  models  and  reinforces  ways  that  students  can  consistently  master  challenging  material  through  effective  effort.  Successfully  challenges  students’  misconceptions  about  innate  ability.  Is  able  to  model  this  element.  

 Formative  Assessment    Quality       *    Scope     *      Consistency     *      Evidence:    

 Summative  Assessment    Quality       *    Scope     *      Consistency     *      Evidence:    

     

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Candidate  Assessment  of  Performance  (CAP)  Form  &  Rubric                                                                                                          7  

IV.A.1:    Reflective  Practice        

IV-­‐A-­‐1.  Reflective  Practice  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  

Demonstrates  limited  reflection  on  practice  and/or  use  of  insights  gained  to  improve  practice.    

May  reflect  on  the  effectiveness  of  lessons/  units  and  interactions  with  students  but  not  with  colleagues  and/or  rarely  uses  insights  to  improve  practice.  

Regularly  reflects  on  the  effectiveness  of  lessons,  units,  and  interactions  with  students,  both  individually  and  with  colleagues,  and  uses  insights  gained  to  improve  practice  and  student  learning.  

Regularly  reflects  on  the  effectiveness  of  lessons,  units,  and  interactions  with  students,  both  individually  and  with  colleagues;  and  uses  and  shares  with  colleagues,  insights  gained  to  improve  practice  and  student  learning.  Is  able  to  model  this  element.  

 Formative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

 Summative  Assessment    Quality       *    

Scope     *      Consistency     *      Evidence:    

     

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Candidate  Assessment  of  Performance  (CAP)  Form  &  Rubric                                                                                                          8  

Candidate  Assessment  of  Performance  Form  and  Rubric  

Section  3:  Summary  and  Signatures    Three-­‐Way  Meetings  

1st  Three-­‐Way  Meeting    Date:    

Candidate    

Supervising  Practitioner    

Program  Supervisor    

2nd  Three-­‐Way  Meeting    Date:    

Candidate    

Supervising  Practitioner    

Program  Supervisor    

Final  Three-­‐Way  Meeting    Date:    

Candidate    

Supervising  Practitioner    

Program  Supervisor      Summary  Ratings  Element   Quality   Consistency   Scope   Readiness  Thresholds  Met?  1.A.4:    Well-­‐Structured  Lessons          1.B.2:    Adjustment  to  Practice          2.A.3:    Meeting  Diverse  Needs          2.B.1:    Safe  Learning  Environment          2.D.2:    High  Expectations          4.A.1:    Reflective  Practice            

Based  on  the  candidate’s  performance  as  measured  on  the  CAP  Rubric,  we  have  

determined  this  candidate  to  be:  Ready  to  Teach  

 

Not  Yet  Ready    

Supervising  Practitioner                                                                                                                                                                                              Date:                              

Program  Supervisor                                                                                                                              Date:

Mediator  (if  necessary  see:  603  CMR  7.04(4))                                                                                                    Date:

   

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Candidate Assessment of Performance (CAP): Three-Way Meeting Checklist

First Three-Way Meeting (occurs within first three weeks)

During 45- 60 min Before After

TC Complete Self-Assessment & Goal-

Setting Forms Share with PS/SP Conduct a Post-Conference for

Announced Obs. #1

Share baseline ratings

Finalize professional practice goal(s)

Agree on implementation plan

Sign-off at conclusion of meeting

Share goals and plan with practicum seminar instructor

SP a

nd

PS

Calibrate feedback from Announced Obs. #1

Review Candidate Self-Assessment & Goal-Setting Form

Prepare to share baseline ratings on CAP Rubric

Act on commitments made in implementation plan

Form

s

Required:

Observation Form: Announced Observation #1

Candidate Self-Assessment & Goal-Setting Form

Optional:

Model Observation Protocol: Post-Conference Planning Form

Candidate Self-Assessment & Goal Setting Form (used by SP/PS to prepare baseline)

Required:

Observation Form: Announced Observation #1

CAP Rubric & Form ((Section 1 & 3)

Optional:

Finalized Goal(s) & Implementation Plan Form

Optional:

Finalized Goal(s) & Implementation Plan Form

Second Three-Way Meeting (occurs half-way through)

During

30-45 min Before After

TC

Administer Student Feedback Surveys Share results with PS/SP

Share formative ratings and discuss

Revisit candidate goals and implementation plan; adjust accordingly (including potentially

modifying the goal, increasing supports, adding additional observations, etc.)

Sign-off at conclusion of meeting

Share formative assessment and updated goals and plan with practicum seminar instructor

SP a

nd

PS

Review all available evidence (including observations, student feedback, measures of student learning, self-reflections forms etc.).

Individually assess candidate performance using the CAP Rubric

Calibrate formative assessment ratings

Schedule/conduct additional observations

Act on commitments made in implementation plan

Form

s

Required:

CAP Rubric & Form (Section 2: Formative Assessment)

Required:

CAP Rubric & Form (Section 3)

Optional:

Finalized Goal(s) & Implementation Plan Form

Optional:

Finalized Goal(s) & Implementation Plan Form

Unannounced Observation #1 (SP) and Announced Observation #2 (PS)

Announced Observation #1 (PS & SP)

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Candidate Assessment of Performance (CAP): Three-Way Meeting Checklist

Final Three-Way Meeting (in final two weeks)

During

30-45 min Before After

TC

Share evidence of performance including, but not limited to: candidate artifacts, measures of student learning, student feedback Share summative ratings and

discuss

Sign-off at conclusion of meeting

Draft a professional practice goal to use during first (or next) year of employment

SP a

nd

PS

Review all available evidence

Individually assess candidate performance using the CAP Rubric

Calibrate summative assessment ratings

Ensure all documents are retained in candidate files

Submit summative assessment data

Form

s

Required:

CAP Rubric & Form (Section 2: Summative Assessment &, Section 3)

Required:

CAP Rubric & Form (section 3)

Unannounced Observation #2 (SP – PS optional but encourage)

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    CAP  Model  Protocol:  Pre-­‐Conference  Planning  Form    

Observation  Protocol:  Pre-­‐Conference  Planning  Form    

Observation  Details    

Date:     Time  (start/end):      

Content  Topic/Lesson  Objective:    

   

Whole  Group      

Small  Group      

One-­‐on-­‐One      

Other    

Element   Evidence  

1.A.4:  Well-­‐Structured  Lessons    

1.B.2:  Adjustments  to  Practice    

2.A.3:  Meeting  Diverse  Needs    

2.B.1:  Safe  Learning  Environment    

2.D.2:  High  Expectations    

4.A.1:  Reflective  Practice    

 Refinement  areas  previously  identified  

 

 Questions  to  ask  in  pre-­‐conference    

Supervising  Practitioner                                                                                                                                                                                              Date:                              

Program  Supervisor                                                                                                                              Date:

 

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                                     CAP  Model  Protocol:  Post-­‐Conference  Planning  Form    

Model  Observation  Protocol:  Post-­‐Conference  Planning  Form    

Observation  Details    

Date:     Time  (start/end):      

Content  Topic/Lesson  Objective:    

 

Refinement  Area  #1  

   

1.A.4:  Well  Structured  Lessons    

 

2.B.1  Safe  Learning  Environment  

   

1.B.2:  Adjustments  to  Practice    

 

2.D.2  High  Expectations  

   

2.A.3:  Meeting  Diverse  Needs    

 

4.A.1  Reflective  Practice  

Self-­‐Reflection  Question(s)  to  prompt  candidate  

 

Evidence  from  Observation  

 

Recommended  Action      

Potential  Resources/Guided  Practice/Training  to  support  

 

 

Refinement  Area  #2  

   

1.A.4:  Well  Structured  Lessons    

 

2.B.1  Safe  Learning  Environment  

   

1.B.2:  Adjustments  to  Practice    

 

2.D.2  High  Expectations  

   

2.A.3:  Meeting  Diverse  Needs    

 

4.A.1  Reflective  Practice  

Self-­‐Reflection  Question(s)  to  prompt  candidate  

 

Evidence  from  Observation  

 

Recommended  Action      

Potential  Resources/Guided  Practice/Training  to  support  

 

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                                     CAP  Model  Protocol:  Post-­‐Conference  Planning  Form          

Reinforcement  Area  #1  

   

1.A.4:  Well  Structured  Lessons    

 

2.B.1  Safe  Learning  Environment  

   

1.B.2:  Adjustments  to  Practice    

 

2.D.2  High  Expectations  

   

2.A.3:  Meeting  Diverse  Needs    

 

4.A.1  Reflective  Practice  

Evidence  from  Observation    

Recommended  Action      

 

Reinforcement  Area  #2  

   

1.A.4:  Well  Structured  Lessons    

 

2.B.1  Safe  Learning  Environment  

   

1.B.2:  Adjustments  to  Practice    

 

2.D.2  High  Expectations  

   

2.A.3:  Meeting  Diverse  Needs    

 

4.A.1  Reflective  Practice  

Evidence  from  Observation    

Recommended  Action      

     Upcoming  Steps  in  the  CAP  Process  • Type  of  Next  Observation:  • Focus  of  Next  Observation:  • Date/topic  of  next  three-­‐way  meeting:    • Other:    

Supervising  Practitioner                                                                                                                                                                                              Date:                              

Program  Supervisor                                                                                                                              Date:

 

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  Candidate  Assessment  of  Performance  (CAP):  Self-­‐Assessment  Form  

Dimensions  of  Readiness:  Quality:  ability  to  perform  the  skill,  action  or  behavior;  Consistency:  the  frequency  (e.g.,  all  the  time,  sometimes,  once)  that  the  skill,  action  or  behavior  is  demonstrated  with  quality;  Scope:  the  scale  of  impact  (e.g.,  one  student,  subset  of  children,  all  students)  to  which  the  skill,  action  or  behavior  is  demonstrated  with  quality  

 

Candidate  Self-­‐Assessment  Form  Directions:  Independently,  reflect  on  your  performance  in  each  dimension  of  an  element.  Use  the  performance  descriptors  from  the  CAP  Rubric  to  help  ground  your  assessment.  Authenticity  is  encouraged.  Consider  the  following  in  rating  your  current  level  of  performance  (as  applicable):    

• Skills  acquired  in  coursework  • Experiences  in  pre-­‐practicum  • Targeted  feedback  you  have  received  about  your  practice  • Evidence  of  impact  with  students  • Reflection  on  performance  in  Announced  Observation  #1  

 I.A.4:  Well-­‐Structure  Lessons  

I-­‐A-­‐4.  Well-­‐

Structured  Lessons  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Develops  lessons  with  inappropriate  student  engagement  strategies,  

pacing,  sequence,  activities,  materials,  resources,  and/or  grouping  for  the  intended  outcome  or  for  the  students  

in  the  class.  

Develops  lessons  with  only  some  elements  of  appropriate  student  

engagement  strategies,  pacing,  sequence,  activities,  materials,  resources,  and  

grouping.  

Develops  well-­‐structured  lessons  with  challenging,  measurable  objectives  and  

appropriate  student  engagement  strategies,  

pacing,  sequence,  activities,  materials,  resources,  

technologies,  and  grouping.  

Develops  well-­‐structured  and  highly  engaging  lessons  

with  challenging,  measurable  objectives  and  

appropriate  student  engagement  strategies,  

pacing,  sequence,  activities,  materials,  resources,  

technologies,  and  grouping  to  attend  to  every  student’s  needs.  Is  able  to  model  this  

element.  

Quality          Scope          Consistency          

 I.B.2:  Adjustment  to  Practice  

I-­‐B-­‐2.  Adjustment  to  Practice  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Makes  few  adjustments  to  practice  based  on  formal  and  informal  assessments.    

May  organize  and  analyze  some  assessment  results  but  only  occasionally  

adjusts  practice  or  modifies  future  instruction  based  on  

the  findings.    

Organizes  and  analyzes  results  from  a  variety  of  assessments  to  determine  progress  toward  intended  outcomes  and  uses  these  findings  to  adjust  practice  

and  identify  and/or  implement  appropriate  

differentiated  interventions  and  enhancements  for  

students.    

Organizes  and  analyzes  results  from  a  

comprehensive  system  of  assessments  to  determine  progress  toward  intended  outcomes  and  frequently  uses  these  findings  to  

adjust  practice  and  identify  and/or  implement  

appropriate  differentiated  interventions  and  enhancements  for  

individuals  and  groups  of  students  and  appropriate  modifications  of  lessons  and  units.  Is  able  to  model  

this  element.  

Quality          Scope          Consistency          

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  Candidate  Assessment  of  Performance  (CAP):  Self-­‐Assessment  Form  

Dimensions  of  Readiness:  Quality:  ability  to  perform  the  skill,  action  or  behavior;  Consistency:  the  frequency  (e.g.,  all  the  time,  sometimes,  once)  that  the  skill,  action  or  behavior  is  demonstrated  with  quality;  Scope:  the  scale  of  impact  (e.g.,  one  student,  subset  of  children,  all  students)  to  which  the  skill,  action  or  behavior  is  demonstrated  with  quality  

 

 II.A.3:  Meeting  Diverse  Needs  

II-­‐A-­‐3.  Meeting  Diverse  Needs  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Uses  limited  and/or  

inappropriate  practices  to  accommodate  differences.  

May  use  some  appropriate  practices  to  accommodate  differences,  but  fails  to  

address  an  adequate  range  of  differences.    

Uses  appropriate  practices,  including  tiered  instruction  

and  scaffolds,  to  accommodate  differences  in  learning  styles,  needs,  interests,  and  levels  of  

readiness,  including  those  of  students  with  disabilities  

and  English  learners.  

Uses  a  varied  repertoire  of  practices  to  create  

structured  opportunities  for  each  student  to  meet  or  

exceed  state  standards/local  curriculum  

and  behavioral  expectations.  Is  able  to  model  this  element.  

Quality          Scope          Consistency          

     

II.B.1:    Safe  Learning  Environment    

II-­‐B-­‐1.  Safe  

Learning  Environment  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Maintains  a  physical  

environment  that  is  unsafe  or  does  not  support  

student  learning.  Uses  inappropriate  or  ineffective  rituals,  routines,  and/or  responses  to  reinforce  positive  behavior  or  

respond  to  behaviors  that  interfere  with  students’  

learning.  

May  create  and  maintain  a  safe  physical  environment  

but  inconsistently  maintains  rituals,  routines,  and  responses  needed  to  

prevent  and/or  stop  behaviors  that  interfere  

with  all  students’  learning.  

Uses  rituals,  routines,  and  appropriate  responses  that  create  and  maintain  a  safe  physical  and  intellectual  environment  where  

students  take  academic  risks  and  most  behaviors  that  interfere  with  learning  

are  prevented.    

Uses  rituals,  routines,  and  proactive  responses  that  create  and  maintain  a  safe  physical  and  intellectual  environment  where  

students  take  academic  risks  and  play  an  active  role—individually  and  

collectively—in  preventing  behaviors  that  interfere  with  learning.  Is  able  to  model  this  element.  

Quality          Scope          Consistency          

     

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  Candidate  Assessment  of  Performance  (CAP):  Self-­‐Assessment  Form  

Dimensions  of  Readiness:  Quality:  ability  to  perform  the  skill,  action  or  behavior;  Consistency:  the  frequency  (e.g.,  all  the  time,  sometimes,  once)  that  the  skill,  action  or  behavior  is  demonstrated  with  quality;  Scope:  the  scale  of  impact  (e.g.,  one  student,  subset  of  children,  all  students)  to  which  the  skill,  action  or  behavior  is  demonstrated  with  quality  

 

 II.D.2:    High  Expectations      

II-­‐D-­‐2.  High  

Expectations  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Gives  up  on  some  students  or  communicates  that  some  cannot  master  challenging  material.  

May  tell  students  that  the  subject  or  assignment  is  challenging  and  that  they  need  to  work  hard  but  does  little  to  counteract  student  misconceptions  about  

innate  ability.    

Effectively  models  and  reinforces  ways  that  students  can  master  challenging  material  

through  effective  effort,  rather  than  having  to  

depend  on  innate  ability.  

Effectively  models  and  reinforces  ways  that  

students  can  consistently  master  challenging  material  through  effective  effort.  Successfully  challenges  

students’  misconceptions  about  innate  ability.  Is  able  to  model  this  element.  

Quality          Scope          Consistency            

   

IV.A.1:    Reflective  Practice        

IV-­‐A-­‐1.  Reflective  Practice  

Unsatisfactory   Needs  Improvement   Proficient   Exemplary  Demonstrates  limited  reflection  on  practice  and/or  use  of  insights  

gained  to  improve  practice.    

May  reflect  on  the  effectiveness  of  lessons/  units  and  interactions  with  

students  but  not  with  colleagues  and/or  rarely  uses  insights  to  improve  

practice.  

Regularly  reflects  on  the  effectiveness  of  lessons,  

units,  and  interactions  with  students,  both  individually  and  with  colleagues,  and  uses  insights  gained  to  improve  practice  and  student  learning.  

Regularly  reflects  on  the  effectiveness  of  lessons,  

units,  and  interactions  with  students,  both  individually  and  with  colleagues;  and  uses  and  shares  with  

colleagues,  insights  gained  to  improve  practice  and  

student  learning.  Is  able  to  model  this  element.  

Quality          Scope          Consistency          

   

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  Candidate  Assessment  of  Performance  (CAP):  Self-­‐Assessment  Form    

   

4    

Candidate  Self-­‐Assessment:  Summary  Sheet    

Name:     Date:      

Directions:  In  the  table  below,  please  record  the  rating  for  each  element.  Use  the  following  key:  Exemplary  (E),  Proficient  (P),  Needs  Improvement  (NI),  Unsatisfactory  (U)    

Self-­‐Assessment  Summary  Element   Quality   Consistency   Scope  1.A.4:    Well-­‐Structured  Lessons        1.B.2:    Adjustment  to  Practice        2.A.3:    Meeting  Diverse  Needs        2.B.1:    Safe  Learning  Environment        2.D.2:    High  Expectations        4.A.1:    Reflective  Practice        

 Based  on  your  Self-­‐Assessment,  briefly  summarize  your  areas  of  strength  and  high-­‐priority  areas  for  growth.      Area(s)  of  Strength   Evidence/Rationale   Element/Dimension        

     

 Area(s)  for  Growth   Evidence/Rationale   Element/Dimension        

     

   Please  share  your  Self-­‐Assessment  Summary  as  well  as  the  Goal  Setting  &  Plan  Development  Forms  with  your  Program  Supervisor  and  Supervising  Practitioner  at  least  three  days  in  advance  of  the  initial  Three-­‐Way  Meeting,  or  earlier  upon  request.      

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  CAP  Protocol:  Candidate  Self-­‐Reflection  Form  

Candidate  Self-­‐Reflection  Form    Directions:  Following  an  announced  or  an  unannounced  observation,  please  use  the  form  below  to  reflect  on  the  lesson.  Submit  the  form  to  your  Supervising  Practitioner/Program  Supervisor  within  24  hours  of  the  observation.      

Observation  Details    

Date:     Time  (start/end):      

Content  Topic/    Lesson  Objective:    

Type  of  Observation:   Observed  by:  

   

Announced      

Unannounced      

Supervising  Practitioner    

 

Program  Supervisor  

 Reflection  Prompt:  What  do  you  think  went  particularly  well?  How  did  this  strength  impact  your  students’  learning?  

 

 Reflection  Prompt:  If  you  could  teach  this  lesson  again,  is  there  anything  you  would  do  differently?  How  would  this  have  impacted  your  students’  learning?    

 

Essential  Element  Evidence:  Where  possible,  provide  one  piece  of  evidence  that  you  believe  demonstrates  your  performance  relative  to  the  quality,  consistency  or  scope  of  each  element.    

1.A.4:  Well-­‐Structured  Lessons    

1.B.2:  Adjustments  to  Practice    

2.A.3:  Meeting  Diverse  Needs    

2.B.1:  Safe  Learning  Environment    

2.D.2:  High  Expectations    

Candidate                                                                                                                                                                                              Date:                              

Supervising  Practitioner                                                                                                                                                                                              Date:                              

Program  Supervisor                                                                                                                              Date:  

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Candidate  Assessment  of  Performance  (CAP):  Goal-­‐Setting  &  Plan  Development    

Preliminary  Goal-­‐Setting  &  Plan  Development    

Name:     Date:      Prompt:  Identify/Clarify  a  Focus  or  Goal  Topic  (Essential  Element,  See  Self-­‐Assessment  Form)    

 Strategic  Prompt:  Why  is  this  topic/focus  area  important?      

 

Objective:    

 Specific,  Rigorous,  Results-­‐Focused  Prompt:  What  skills,  knowledge,  or  practice  will  I  acquire  or  develop  through  achieving  this  goal?    

 Realistic,  Timed  Prompt:  When  will  I  achieve  this  goal?    

 Action-­‐Oriented,  Tracked  Prompt:  How  will  I  demonstrate  progress  toward  this  goal?    

 Measured  Prompt:  How  will  I  know  the  goal  has  been  achieved?    

 

Draft  Professional  Practice  Goal:    

 

What  actions  will  you  take  to  achieve  the  goal?  What  actions/supports/resources  will  you  need  from  your  Program  Supervisor  and  Supervising  

Practitioner?  •   •  

 

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Candidate  Assessment  of  Performance  (CAP):  Candidate  Goal(s)  &  Implementation  Plan    

Candidate  Professional  Practice  Goal(s)  &  Implementation  Plan    Name:     Date:      Goal(s):  Based  on  the  candidate’s  self-­‐assessment  and  the  baseline  ratings  determined  by  the  Program  Supervisor  and  Supervising  Practitioner,  the  candidate  has  set  the  following  S.M.A.R.T  goal(s):  

 Implementation  Plan:  In  support  of  attaining  the  goal(s),  the  candidate,  Program  Supervisor  and  Supervising  Practitioner  agree  on  the  following  actions  (add  more  rows  as  needed):  

Action   Supports/Resources  from     Timeline/Frequency        

     

     

     

 Measure  of  Student  Learning:  In  addition  to  attaining  the  professional  practice  goal,  the  candidate  will  also  be  assessed  based  in  part  on  their  impact  on  student  learning.  The  Supervising  Practitioner,  in  coordination  with  the  Program  Supervisor,  has  set  the  following  measures  of  student  learning.    

Measure  of  Student  Learning   Impact  Rating   Parameters     High    

Moderate    

Low    

 

CAP  Professional  Practice  Goal(s)    

Essential  Element  

 

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ESE Model Student Feedback Survey Grades 3-5: Short Form

School Year 2014-15 Page 1 of 3 © 2014 Massachusetts Department of Elementary and Secondary Education. Permission is hereby granted to copy any or all parts of this document for non-commercial educational purposes. Please credit the “Massachusetts Department of Elementary and Secondary Education.”

Name of teacher: _____________________________________ Date: ______________________

Directions: Read each statement and then choose one answer choice that you think fits best. There are no right or wrong answers. Your teacher will use your class’s answers to better understand what it’s like to be a student in this class. Your teacher will not see your individual answers.

Strongly Agree Agree Disagree

Strongly Disagree

1. In this class, students help each other to learn.

○ ○ ○ ○

2. When my teacher is talking, he or she asks us if we understand.

○ ○ ○ ○

3. My teacher asks me to improve my work when he or she knows I can do better.

○ ○ ○ ○

4. When we can't figure something out, my teacher gives us other activities to help us understand.

○ ○ ○ ○

5. My teacher uses our mistakes as a chance for us all to learn.

○ ○ ○ ○

6. The work in this class is challenging but not too difficult for me.

○ ○ ○ ○

7. When asked, I can explain what I am learning and why.

○ ○ ○ ○

8. I use evidence to explain my thinking when I write, answer questions, and talk about my work.

○ ○ ○ ○

9. I can show my learning in many ways (e.g., writing, graphs, pictures).

○ ○ ○ ○

10. I can do more challenging work when I am waiting for other students to finish.

○ ○ ○ ○

11. My teacher shows us how to respect different opinions in class.

○ ○ ○ ○

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ESE Model Student Feedback Survey Grades 3-5: Short Form

School Year 2014-15 Page 2 of 3 © 2014 Massachusetts Department of Elementary and Secondary Education. Permission is hereby granted to copy any or all parts of this document for non-commercial educational purposes. Please credit the “Massachusetts Department of Elementary and Secondary Education.”

Strongly Agree Agree Disagree

Strongly Disagree

12. My teacher usually knows when I am confused and helps me understand.

○ ○ ○ ○

13. After I talk to my teacher, I know how to make my work better.

○ ○ ○ ○

14. When we read in class, I can think of several possible answers to my teacher’s questions.

○ ○ ○ ○

15. If I am sad or angry, I can talk to my teacher.

○ ○ ○ ○

16. I look over my classmates' work and suggest ways to improve it.

○ ○ ○ ○

17. My classmates behave the way my teacher wants them to.

○ ○ ○ ○

18. My teacher encourages us to think of more than one way to solve a problem.

○ ○ ○ ○

19. Students encourage each other to do really good work in this class.

○ ○ ○ ○

20. My teacher explains what good work looks like on assignments and projects.

○ ○ ○ ○

21. My teacher asks us to share what we have learned in a lesson.

○ ○ ○ ○

22. My teacher uses things that interest me to explain hard ideas.

○ ○ ○ ○

23. My teacher lets me teach other students how I solved a problem.

○ ○ ○ ○

24. In this class, other students take the time to listen to my ideas.

○ ○ ○ ○

25. My teacher uses my ideas to help my classmates learn.

○ ○ ○ ○

47

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ESE Model Student Feedback Survey Grades 3-5: Short Form

School Year 2014-15 Page 3 of 3 © 2014 Massachusetts Department of Elementary and Secondary Education. Permission is hereby granted to copy any or all parts of this document for non-commercial educational purposes. Please credit the “Massachusetts Department of Elementary and Secondary Education.”

OPTIONAL: If you have any additional feedback for your teacher, please share it here.

48

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ESE Model Student Feedback Survey: ITEM KEY Grades 3-5: Short Form

Page 1 of 1 © 2014 Massachusetts Department of Elementary and Secondary Education. Permission is hereby granted to copy any or all parts of this document for non-commercial educational purposes. Please credit the “Massachusetts Department of Elementary and Secondary Education.”

This item key is not intended for distribution to students. The following table provides a crosswalk between survey items and the Standards and Indicators of Effective Teaching Practice addressed in the model survey. You may sort the table differently by selecting it and finding the Sort function in the Table Layout tab.

Standard I: Curriculum, Planning & Assessment Standard II: Teaching All Students

I.A: Curriculum & Planning I.B: Assessment I.C: Analysis

II.A: Instruction II.B: Learning Environment II.C: Cultural Proficiency II.D: Expectations

Standard/ Indicator

# Item

II.B 1. In this class, students help each other to learn.

I.B 2. When my teacher is talking, he or she asks us if we understand.

II.A 3. My teacher asks me to improve my work when he or she knows I can do better.

II.D 4. When we can't figure something out, my teacher gives us other activities to help us understand.

II.B 5. My teacher uses our mistakes as a chance for us all to learn.

II.D 6. The work in this class is challenging but not too difficult for me.

II.D 7. When asked, I can explain what I am learning and why.

I.A 8. I use evidence to explain my thinking when I write, answer questions, and talk about my work.

II.A 9. I can show my learning in many ways (e.g., writing, graphs, pictures).

II.A 10. I can do more challenging work when I am waiting for other students to finish.

II.C 11. My teacher shows us how to respect different opinions in class.

I.A 12. My teacher usually knows when I am confused and helps me understand. I.C 13. After I talk to my teacher, I know how to make my work better. I.A 14. When we read in class, I can think of several possible answers to my teacher’s questions. II.B 15. If I am sad or angry, I can talk to my teacher. I.C 16. I look over my classmates' work and suggest ways to improve it. II.B 17. My classmates behave the way my teacher wants them to. I.A 18. My teacher encourages us to think of more than one way to solve a problem. II.D 19. Students encourage each other to do really good work in this class. II.D 20. My teacher explains what good work looks like on assignments and projects. I.A 21. My teacher asks us to share what we have learned in a lesson. II.A 22. My teacher uses things that interest me to explain hard ideas. II.A 23. My teacher lets me teach other students how I solved a problem. II.C 24. In this class, other students take the time to listen to my ideas. II.A 25. My teacher uses my ideas to help my classmates learn.

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ESE Model Student Feedback Survey Grades 6-12: Short Form

Page 1 of 2 © 2014 Massachusetts Department of Elementary and Secondary Education. Permission is hereby granted to copy any or all parts of this document for non-commercial educational purposes. Please credit the “Massachusetts Department of Elementary and Secondary Education.”

Name of teacher: _________________________________________ Date: ______________________

Directions: Read each statement and then choose one answer choice that you think fits best. There are no right or wrong answers. Your teacher will use your class’s responses to better understand what it’s like to be a student in this class. Your teacher will not see your individual answers.

Strongly Agree

Agree

Disagree

Strongly Disagree

1. My teacher demonstrates that mistakes are a part of learning.

○ ○ ○ ○

2. My teacher asks us to summarize what we have learned in a lesson.

○ ○ ○ ○

3. Students push each other to do better work in this class.

○ ○ ○ ○

4. My teacher asks me to improve my work when he or she knows I can do better.

○ ○ ○ ○

5. My teacher uses open-ended questions that enable me to think of multiple possible answers.

○ ○ ○ ○

6. Examples of excellent work are provided by my teacher so I understand what is expected of me.

○ ○ ○ ○

7. In this class, students review each other's work and provide each other with helpful advice on how to improve.

○ ○ ○ ○

8. When asked, I can explain what I am learning and why.

○ ○ ○ ○

9. After I get feedback from my teacher, I know how to make my work better.

○ ○ ○ ○

10. The work in this class is challenging but not too difficult for me.

○ ○ ○ ○

11. During our lessons, I am asked to apply what I know to new types of challenging problems or tasks.

○ ○ ○ ○

12. In this class, other students take the time to listen to my ideas.

○ ○ ○ ○ 13. When material in this subject is confusing, my

teacher knows how to break it down so I can understand.

○ ○ ○ ○

14. In my class, my teacher is interested in my well-being beyond just my class work.

○ ○ ○ ○

50

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ESE Model Student Feedback Survey Grades 6-12: Short Form

Page 2 of 2 © 2014 Massachusetts Department of Elementary and Secondary Education. Permission is hereby granted to copy any or all parts of this document for non-commercial educational purposes. Please credit the “Massachusetts Department of Elementary and Secondary Education.”

Strongly Agree

Agree

Disagree

Strongly Disagree

15. If we finish our work early in class, my teacher has us do more challenging work.

○ ○ ○ ○

16. My teacher asks me to rate my understanding of what we have learned in class.

○ ○ ○ ○

17. I use evidence to explain my thinking when I write, present my work, and answer questions.

○ ○ ○ ○

18. In this class, students work together to help each other learn difficult content.

○ ○ ○ ○

19. My teacher helps us identify our strengths and shows us how to use them to help us learn.

○ ○ ○ ○

20. In this class, students are asked to teach other classmates a part or whole lesson.

○ ○ ○ ○

21. Our class stays on task and does not waste time.

○ ○ ○ ○

22. During a lesson, my teacher is quick to change how he or she teaches if the class does not understand (e.g., switch from using written explanations to using diagrams).

○ ○ ○ ○

23. My teacher encourages us to accept different points of view when they are expressed in class.

○ ○ ○ ○

24. I can show my learning in many ways (e.g., writing, graphs, pictures) in this class.

○ ○ ○ ○

25. In this class, students are allowed to work on assignments that interest them personally.

○ ○ ○ ○

OPTIONAL: If you have any additional feedback for your teacher, please share it here.

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ESE Model Student Feedback Survey: ITEM KEY Grades 6-12: Short Form

Page 1 of 2 © 2014 Massachusetts Department of Elementary and Secondary Education. Permission is hereby granted to copy any or all parts of this document for non-commercial educational purposes. Please credit the “Massachusetts Department of Elementary and Secondary Education.”

This item key is not intended for distribution to students. The following table provides a crosswalk between survey items and the Standards and Indicators of Effective Teaching Practice addressed throughout the survey. You may sort the items by Standard/Indicator by selecting the table and finding the Sort function in the Table Layout tab.

Standard I: Curriculum, Planning & Assessment Standard II: Teaching All Students

I.A: Curriculum & Planning I.B: Assessment I.C: Analysis

II.A: Instruction II.B: Learning Environment II.C: Cultural Proficiency II.D: Expectations

Standard/ Indicator

# Item

II.B 1. My teacher demonstrates that mistakes are a part of learning.

I.A 2. My teacher asks us to summarize what we have learned in a lesson.

II.D 3. Students push each other to do better work in this class.

II.A 4. My teacher asks me to improve my work when he or she knows I can do better.

I.A 5. My teacher uses open-ended questions that enable me to think of multiple possible answers.

II.D 6. Examples of excellent work are provided by my teacher so I understand what is expected of me.

I.C 7. In this class, students review each other's work and provide each other with helpful advice on how to improve.

II.D 8. When asked, I can explain what I am learning and why.

I.C 9. After I get feedback from my teacher, I know how to make my work better.

II.D 10. The work in this class is challenging but not too difficult for me.

I.A 11. During our lessons, I am asked to apply what I know to new types of challenging problems or tasks.

II.C 12. In this class, other students take the time to listen to my ideas.

I.A 13. When material in this subject is confusing, my teacher knows how to break it down so I can understand.

II.B 14. In my class, my teacher is interested in my well-being beyond just my class work.

II.A 15. If we finish our work early in class, my teacher has us do more challenging work.

I.B 16. My teacher asks me to rate my understanding of what we have learned in class.

I.A 17. I use evidence to explain my thinking when I write, present my work, and answer questions.

52

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ESE Model Student Feedback Survey: ITEM KEY Grades 6-12: Short Form

Page 2 of 2 © 2014 Massachusetts Department of Elementary and Secondary Education. Permission is hereby granted to copy any or all parts of this document for non-commercial educational purposes. Please credit the “Massachusetts Department of Elementary and Secondary Education.”

Standard/ Indicator

# Item

II.B 18. In this class, students work together to help each other learn difficult content.

II.C 19. My teacher helps us identify our strengths and shows us how to use them to help us learn.

II.A 20. In this class, students are asked to teach other classmates a part or whole lesson.

II.B 21. Our class stays on task and does not waste time.

II.D 22. During a lesson, my teacher is quick to change how he or she teaches if the class does not understand (e.g., switch from using written explanations to using diagrams).

II.C 23. My teacher encourages us to accept different points of view when they are expressed in class.

II.A 24. I can show my learning in many ways (e.g., writing, graphs, pictures) in this class.

II.A 25. In this class, students are allowed to work on assignments that interest them personally.

53