A

REGENT UNIVERSITY SCHOOL OF EDUCATION

Teacher Candidate Personal Data Form

Name_________________________________________________Date_________________________ Address ___________________________________________________________________________ Home Phone No. ________________________ Emergency Phone No._________________________ Email address ___________________________________(Cell)______________________________ Regent University Program of Study_____________________________________________________ ********************************************************************************** Undergraduate College Major _______________________________ Minor _____________________ College/University___________________________________________________________________ Degree Received _______________________________ Date Conferred ________________________ ********************************************************************************** Awards, Achievement, Extra-curricular Activities Which Have Contributed to Your Preparation for Teaching: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Relevant Work Experience During the Last Five Years: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Brief Summary of Professional Goals: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ List Any Special Hobbies, Talents, Interests: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________ Please give a copy of this form to your course professor and /or university supervisor, and also to the school in which you are conducting a practicum or internship.

B

School of Education

Tuberculosis Certificate

As a condition of acceptance, every student will submit this form signed by a licensed physician, or registered nurse, stating said student is free from tuberculosis. The certificate is to be based on recorded results of x-rays, skin tests, and other examinations, singly or in combination, as deemed necessary by the physician that have been performed. To be completed by student: Name___________________________________________________________________ Address_________________________________________________________________ Phone Number___________________________________________________________ Signature_______________________________________ Date_____________________ To be completed by Physician I hereby certify that on the basis of skin tests, x-rays, and other examination, singly or in combination, the above named person appears to be free of communicable tuberculosis. Dates of skin tests, x-rays, and other examinations _______________________________ ________________________________________________________________________ Signature_____________________________________________ Printed Name___________________________________________ Address_________________________________________________________________ ________________________________________________________________________ ______ I am a licensed Physician in _________________________ (state) ______ I am a Registered Nurse licensed pursuant to Virginia’s Board of Nursing. Please return this form to the Coordinator of Licensure Programs FAX: 266.4147

C

SCHOOL OF EDUCATION

PRACTICUM PLACEMENT REQUEST FORM THIS FORM IS FOR ALL SCHOOL DIVIDIONS OTHER THAN VIRGINIA BEACH AND NORFOLK. (Please complete the appropriate form for these school divisions).

Deadlines: February 1 for Summer April 1 for Fall October 1 for Spring Use BLACK ink and PRINT clearly.

PLACEMENT INFORMATION FROM THE TEACHER CANDIDATE Teacher Candidate’s Name________________________________________________________ Phone______________________________ E-Mail__________________________________ Local Address__________________________________________________________________ (Street) (City) (State) (Zip Code) Course Title(s) _____________________________________________________________________ Professor/Instructor(s) _______________________________________________________________ Grade Level Requested_______________________________________________________ Dates Requested____________________________________________________________________ (Beginning) (Ending) Briefly explain any special requests: ____________________________________________________ ____________________________________________________________________________________________________________________________________________________________________

Total Number of Hours______________________

I understand that confidentiality is a legal issue, and I agree not to discuss my experience in a manner that will allow identification of any individual. I will contact the school in advance to arrange a mutually convenient schedule. ___________________________________________ Teacher Candidate’s Signature Date

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * INFORMATION FOR THE TEACHER CANDIDATE

* All practicum requests must be coordinated through the School of Education. * This practicum request will be used for the entire semester, and will be used for all practicum courses that the teacher candidate is registered for in that given semester. * It is the teacher candidate's responsibility to obtain enough hours for each practicum course. For example, 15 hours are needed for each practicum course. * It is the teacher candidate's responsibility to meet the specific requirements for each practicum course. Please see the syllabus and/or contact the professor for such requirements. * Grade levels, schools, and teachers may be requested. However, please realize that not all requests can be honored.

FOR PLACEMENT COORDINATOR'S USE ONLY Teacher Candidate is currently registered for the following courses:____________________________ Teacher Candidate meets all necessary requirements for placement: _______ Placement Coordinator's Signature_______________________________ Date______________ Date Sent to School District for Placement __________________________________________ Date Placement Received from School District _______________________________________ Date Teacher Candidate Notified of Placement _______________________________________

D

School of Education

Teacher Preparation Program Pre K-6 Observation Evaluation

________________________ _____________________ __________________ Teacher Candidate’s Name Social Security Number Home Phone # ________________________ _____________________ __________________

School Principal Subject/Grade ________________________ _____________________ __________________ Course Title & Number Semester Instructor

This placement must total _______ hours or more; the Teacher Candidate should obtain a wide variety of observations with primary emphasis on participation in the classroom. Time Verification: Please record time to the nearest half hour. Each time block requires a verifying teacher’s signature.

Date Hours/Minutes Grade/Subject/Other Teacher’s Signature

Total Hours: ____________

__________________________________ _________________________________________ Teacher Candidate’s Signature Signature of Principal/Assistant Principal

Observation and Participation Response Record Below are several characteristics that have some relationship to success in teaching. Please evaluate the Teacher Candidate by rating him/her in each category. Only respond to characteristics that apply to this observation period.

Characteristics Yes No Not Applicable

Good Attendance/Promptness

Professional appearance

Appropriately courteous to faculty, staff, & students

Ability to establish good rapport with students

**If you have noted any particular strengths or weaknesses please comment: __________________________________________________________________________________________________________________________________________________________________________________________ Check One: _________ I recommend that this Teacher Candidate continue in his/her teacher education program. _________ I do not recommend that this Teacher Candidate continue in his/her teacher education program.

Please mail this completed form to: School of Education Regent University

1000 Regent University Drive Attn: ADM 266, Coordinator of Licensure Programs

Virginia Beach, VA 23464

E

To Be Completed by the Assigned Clinical Faculty Practicum Dates: From: ________ To: __________ Semester/Year: ______________ Course Title & Number: ________________________________ Instructor: ________________________________ Teacher Licensure Candidate: ____________________________ Home Phone: ______________________________ Check one: Undergraduate ٱ Graduate ٱ Licensure Only: ٱ Clinical Faculty___________________________________ Grade_________ Subject_______________ School District____________________________________ School______________________________

Please evaluate this teacher licensure candidate on the basis of his/her potential for teaching based on performance in your classroom using the following scale: 4 = Exceeds Expectation 3 = Meets Expectation 2 = Needs Improvement 1 = Unacceptable 4 3 2 1 1. Personal Conduct Well-groomed and appropriately dressed Reliable, dependable and punctual Shows initiative and willingness to assume responsibility 2. Communication Skills Uses oral communication skills effectively Uses written communication skills effectively 3. Relationship with District Staff, School Staff and Parents Tutoring (one-on-one) Small group instruction Large group instruction Helping with special projects 4. Teaching Plans and Materials Plans activities that are appropriate to stated objectives and learning needs of students Plans lesson procedures in detailed manner Reviews and modifies plans as necessary to teach effectively 5. Classroom Management and Interaction Maintains focus on the lesson plan Handles disruptions effectively Follows recognized class procedures 6. Classroom Instruction Practices Presents a structured lesson: reviews concepts and skills, states, objectives, and provides meaningful activities

7. Feedback to Students Includes appropriate evaluation in lesson plans Develops and implements tests 8. Demonstration of Content Knowledge Demonstrates knowledge and skill in major subject areas 9. Impact on Student Learning Monitors activities and evaluates progress during instruction through questioning, observation, checking work, and assessment of the learning objectives

Practicum Evaluation Teacher Preparation PreK-6

4 3 2 1 __________________________________ ____________________________________ Signature of Clinical Faculty Date Signature of Regent Faculty Date

Please mail this completed form to: School of Education Regent University

1000 Regent University Drive Attn: ADM 266, Coordinator of Licensure Programs

Virginia Beach, VA 23464

F

1000 Regent University Drive Virginia Beach, VA 23464 Clinical Faculty STIPEND Form (Internship)

This form should be completed by the individual who is designated as the clinical faculty. Please return the form to Regent University, School of Education, 1000 Regent University Drive, Virginia Beach, VA 23464-9800. ATT: Dr. Carla Bergdoll, Coordinator of Licensure Programs. Name of Clinical Faculty _________________________________________________________________ Last First Middle Address ________________________________________________________________________________ Street City State Zip Social Security Number __________________________________________________________________ Home Phone Number ______________________ Work Phone Number _____________________ Email Address ___________________________________________________________________ School Name and Address __________________________________________________________ School Division __________________________________________________________________ Name Of Teacher Candidate ________________________________________________________ Signature of Clinical Faculty _______________________ Date ___________________________ FAX: 226.4147

G

1000 Regent University Drive Virginia Beach, VA 23464 Clinical Faculty Information Form (Practicum)

This form should be completed by the individual who is designated as the clinical faculty. Please return the form to Regent University, School of Education, 1000 Regent University Drive, Virginia Beach, VA 23464-9800. ATT: Dr. Carla Bergdoll, Coordinator of Licensure Programs. Name of Clinical Faculty _________________________________________________________________ Last First Middle Address ________________________________________________________________________________ Street City State Zip Social Security Number __________________________________________________________________ Home Phone Number ______________________ Work Phone Number _____________________ Email Address ___________________________________________________________________ School Name and Address __________________________________________________________ School Division __________________________________________________________________ Name Of Teacher Candidate ________________________________________________________ Signature of Clinical Faculty _______________________ Date ___________________________ FAX: 226.4147

H

School of Education Elementary Education PreK-6 Licensure Program

Internship Application

Deadline for Application: April 1 for fall term. October 15 for Spring term February 1 for summer term Personal and Professional Information (Please PRINT clearly) Name________________________________________________ SSN_______________________________________________ Address________________________________________________City/State/Zip ______________________________________ Phone (home) ____________________ (work) __________________ (cell) ____________ Regent E-mail ___________________ Internship Information Preferred School District & School Name (1st 8 week placement) ____________________________________________________ Preferred School District & School Name (2nd 8 week placement) ____________________________________________________ Clinical Faculty Request (1st 8 week placement) __________________________________________________________________ Clinical Faculty Request (2nd 8 week placement) _________________________________________________________________ *NOTE: If you are working in a school as an aide or other paraprofessional and would like to do your internship experience in the same school, please note that above. Indicate the school, appropriate contact person in authority, and the name of the teacher with whom you would like to work. Period of semester: Semester________________ Year_____________________ Grade-Level Preference (rank 1-3) PreK-3 Elementary_____ 4-5 Elementary_____ 6 Middle___________ Courses you will take in conjunction with student teaching__________________________________________________________ Program completion date______________ A Placement WILL NOT be processed until the following items are on file in the Coordinator of Licensure Programs office: Have you obtained Liability Insurance? __________ Please provide copy of policy. Have you completed a background check? ________ Please provide notarized verification. Have you obtained a TB test? ________________ Please provide verification. Passing Scores on Praxis I ________________ Teacher Candidate’s Signature_________________________________________ Date_________________ For Administrative Use ONLY: School Division ______________________________ School Name ______________________________ Grades ____ Clinical Faculty Name(s) _____________________________________ Dates of Internship________________________ Verification of all required documentation _____________

Deadline for Application: April 1 for Fall October 15 for Spring February 1 for summer (10.6.04)

I

SCHOOL OF EDUCATION

Teacher Candidate's Self-Evaluation of Field Experience (practicum or internship) Teacher Candidate's Name: _____________________________________ Dates of Placement: ________________ Clinical Faculty's Name: ________________________________________ School: ___________________________ Professor: ____________________________________________________ Course/Semester: __________________ Complete the evaluation of your field experience. The intent of this evaluation is to serve both as a self-examination of your growth and also as a means of helping faculty members improve the teacher preparation program at Regent University. Return your completed evaluation form to your field experience professor or university supervisor.

During this field experience, my performance Below Meets Exceeds in each of the following areas was… Expectations Expectations Expectations Punctuality Dependability Organization and Preparation Communication Skills Appearance and Dress Effort and Initiative Cooperativeness and Flexibility Enthusiasm Attention to Student Safety Contribution to a Positive Learning Environment Rapport with Students Rapport with Parents and Other Community Members Rapport with Faculty and Other School Personnel Professional Demeanor Reflection upon Practice Potential for Leadership

Based on your experiences and coursework to date, please provide a written evaluation of your strengths, weaknesses and development in becoming an effective teacher. (Attach a separate sheet, if necessary.) _______________________________________ Teacher Candidate’s Signature Date

J

SCHOOL OF EDUCATION

Internship --Weekly Evaluation of Teacher Candidate by Clinical Faculty Teacher Candidate's Name: _____________________________________ Date: _____________________________ Clinical Faculty: _______________________________________________ School: ___________________________ This form has been designed to help clinical faculty give the teacher candidate frequent specific feedback. After checking the applicable items in each area, please turn the page and provide specific information regarding strengths and areas for improvement.

PROFESSIONAL ATTRIBUTE SCALE 1. Attendance 2. Punctuality 3. Oral Expressions ___ Frequently absent ___ Frequently late ___Makes frequent usage/grammatical errors ___ Rarely absent ___ Generally punctual ___ Inarticulate ___ Exemplary attendance ___ Always on time ___ Articulate ___ Expressive, animated 4. Written Expression 5. Tact/Judgment 6. Reliability/Dependability ___ Written works demonstrate frequent misspellings ___ Thoughtless: Insensitive to others' feelings ___Sometimes fails to complete assigned tasks and/or grammatical errors and opinions and duties ___ Writing is often unclear or disorganized ___ Limited sensitivity and diplomacy ___ Sometimes needs to be reminded to attend ___ Organizes and clearly expresses ideas ___ Perceives what to do or say in order to to assigned tasks or duties ___ Frequently and effectively communicates with maintain good relations with others and ___ Responsible: Attends to assigned tasks or parents and/or administrators and responds accordingly duties ___ Highly sensitive to others' feelings and ___ Self-starter: Perceives needs and attends to opinions: Diplomatic them immediately 7. Self-Initiative/Independence 8. Collegiality 9. Relating Theory to Practice __ Passive: Depends on others for direction, ideas ___ Prefers to work in isolation ___ No evidence of implementing pedagogical and guidance ___ Reluctant to share ideas and materials theories __ Has good ideas, works effectively with limited ___ Prefers being part of a team ___ Sometimes relates theory to practice supervision ___ Willingly shares ideas and materials ___ Frequently bases practical work on sound __ Creative and resourceful: Independently pedagogical theory implements plans 10. Response to Feedback 11. Interaction with Students 12. Interaction with School ___ Unreceptive to feedback ___ Sometimes antagonistic towards student Faculty/Staff ___ Receptive - BUT doesn't implement suggestions ___ Shy: Hesitant to work with students ___ Is sometimes antagonistic ___ Receptive - AND adjusts performance ___ Relates easily and positively with students ___ Shy: Hesitant to work with school personnel accordingly ___ Outgoing: Actively seeks opportunities to ___ Relates easily and positively ___ Solicits suggestions and feedback from others work with students ___ Outgoing: Actively seeks opportunities to ___ Accepts responsibility for student learning work with school personnel INSTRUCTIONAL DEVELOPMENT SCALE. Summarize the proficiency level for each area listed. Identify at least two areas of instructional strength your teacher candidate demonstrated this week (Indicate with a "+"). Then identify at least two areas that the teacher candidate needs to focus on for the following week (Indicate with a "√"). After checking items in each area, please turn the page and provide more specific information. Teaching Plans and Materials 1. Plan has objectives for current lesson □ 15. Collects, reviews, and grades homework, and links to classroom instruction □ 2. Plan has objectives related to appropriate SOL (if applicable) □ 16. Begins lesson on schedule □ 3. Plan is suitable for diverse learners □ 17. Uses student responses and questions in teaching □ 4. Plan has procedures for regularly assessing student progress and □ 18. Uses appropriate wait time for students after asking questions □ making adjustments 19. Uses effective closure or summarization techniques □ 5. Plans are given to clinical faculty in advance □ 20. Uses instructional time effectively □ Classroom Management, Interaction and Feedback 21. Content information is accurate and current □ 6. Provides behavioral expectations at beginning of lesson □ 22. Students are asked higher order questions □ 7. Reinforces appropriate student behavior □ 23. Effectively incorporates technology into instruction □ 8. Demonstrates enthusiasm for teaching □ Impact on Student Learning 9. Provides feedback to students about behavior □ 24. Student learning is evidenced by frequent work samples □ 10. Maintains positive classroom behavior □ 25. Student learning is evidenced by active engagement in class □ 11. Encourages students when they have difficulty □ 26. Student learning is evidenced by positive social interactions with peers Classroom Instructional Practice and Content Knowledge and school personnel □ 12. Starts lesson from a point of engagement □ 27. Student learning is evidenced by high rate of correct responses and13. Provides objectives and establishes student's prior knowledge □ successful performance on quizzes and tests (See Next Page) □ 14. Provides opportunities for students to be actively engaged □

K

WEEKLY FEEDBACK GUIDE (continued) If there are elements of professional development or instructional development competencies that need more attention, please provide specific examples of how the teacher candidate may strengthen these areas. ______________________________ _____________________ Clinical Faculty Signature Date Teacher Candidate Signature / Date In the space below, the teacher candidate will briefly outline plans to strengthen or improve areas noted above by the clinical faculty.

L

SCHOOL OF EDUCATION

Report of University Supervisor’s Internship Observation and Conference Teacher Candidate's Name: _____________________________________ Date of Visit:_______________ Clinical Faculty's Name: _______________________________________ School: ___________________ Date/Time of Next Visit: _________________________________________________________________ Lesson Plan Comments _________________________________________________________________________________________________________________________________________________________ Weekly Journal Review ________________________________________________________________________________________________________________________________________________________ Observations: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Went well: Do differently:

Strengths: Refinement:

Focus for next observation: _______________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ __________________________________ __________________________________ Signature of Teacher Candidate Date Signature of University Supervisor Date

M

School of Education

Internship Evaluation: Midterm / Final by Clinical Faculty

Name of Teacher Candidate_________________________________________________________ Endorsement Area______________________________________ Age/Grade________________ Level__________________________________________________________________________ Internship Dates: Began___________________________________Concluded______________________________ School__________________________________ District________________________________ State___________________ Evaluator’s Name_____________________________________________ Evaluator’s Position___________________________________________ Please rate the teacher candidate’s performance according to the following rubric: 5 = Outstanding 4 = Above Average 3 = Satisfactory 2 = Needs Improvement 1 = Unsatisfactory 0 = No Opportunity to Observe I. Instructional Planning and Delivery

1. Uses formal and informal assessment data to make instructional decisions. 0 1 2 3 4 5

2. Plans instruction based on objectives and core curriculum demands. 0 1 2 3 4 5

3. Designs instruction that academically addresses learning style and motivation, as well as behavioral and academic needs. 0 1 2 3 4 5 4. Plans instruction based on diagnostic teaching. 0 1 2 3 4 5 5. Designs instruction that includes review, teacher presentation, guided and independent practice, immediate feedback and delayed testing. 0 1 2 3 4 5 6. Designs and implements instruction that facilitates retention and transfer. 0 1 2 3 4 5

7. Involves students with daily visual charting of academic and behavioral performance. 0 1 2 3 4 5 8. Demonstrates effective use of instructional time. 0 1 2 3 4 5

9. Uses relevant example and demonstration to illustrate concepts and skills. 0 1 2 3 4 5

10. Makes efficient transitions between instructional activities. 0 1 2 3 4 5

11. Summarizes the main points at the end of the lesson. 0 1 2 3 4 5

12. Incorporates all language modes in instructional planning and delivery. 0 1 2 3 4 5

13. Uses signals, cues, and questioning appropriately.

N

0 1 2 3 4 5 14. Conducts and uses task analysis.

0 1 2 3 4 5 15. Integrates effective social skills, as well as career and vocational skills with

academic curricula. 0 1 2 3 4 5

16. Uses computer technology when appropriate. 0 1 2 3 4 5

17. Uses research-based instructional approaches and techniques. 0 1 2 3 4 5

Comments: II. Management A. Behavior

1. Utilizes a predetermined set of behavior management rules and procedures. 0 1 2 3 4 5

2. Anticipates behavior problems (signals, behavioral indicators) and responds. 0 1 2 3 4 5

3. Designs and implements appropriate behavior intervention plans. 0 1 2 3 4 5

4. Designs and implements strategies for social skill instruction. 0 1 2 3 4 5

5. Uses knowledge about students to prevent behavior problems. 0 1 2 3 4 5

Comments:

B. Instructional 1. Utilizes an established set of rules and procedures that govern the handling of routine administrative matters. 0 1 2 3 4 5 2. Plans and directs the activities of a classroom paraprofessional, aide, volunteer, or peer tutor.

0 1 2 3 4 5 3. Arranges classroom environment for effective learning. 0 1 2 3 4 5 Comments:

III. Communication

O

1. Uses voice tone and facial expressions for emphasis, management, and expression. 0 1 2 3 4 5

2. Actively listens and appropriately responds to students, parents, teachers, and administrators, and other school personnel. 0 1 2 3 4 5

3. Collaborates with parents, classroom teachers, and other school/community personnel. 0 1 2 3 4 5

4. Communicates specific information on student performance to teachers, administrators, parents, and other school professionals. 0 1 2 3 4 5

5. Chooses language appropriate to learner needs. 0 1 2 3 4 5

6. Builds an interactive learning community with students. 0 1 2 3 4 5

7. Demonstrates ability to problem solve as well as manage resistance and conflict in interactions with students and professionals. 0 1 2 3 4 5

8. Writes appropriate goals and objectives. 0 1 2 3 4 5

9. Understands and respects individual differences. 0 1 2 3 4 5

Comments: IV. Evaluation and Assessment

1. Examines student educational files and understands and utilizes assessment data. 0 1 2 3 4 5

2. Conducts and analyzes functional assessment of behavior. 0 1 2 3 4 5

3. Uses direct observation techniques to gather data and design behavioral interventions. 0 1 2 3 4 5

4. Conducts diagnostic assessment for instructional purposes. 0 1 2 3 4 5

5. Monitors daily academic progress. 0 1 2 3 4 5

6. Provides immediate feedback. 0 1 2 3 4 5

7. Sequences, implements, and evaluates individual learning objectives. 0 1 2 3 4 5

8. Critiques daily performance. 0 1 2 3 4 5

9. Keeps anecdotal record of student behavior. 0 1 2 3 4 5

Comments: V. Professional and Ethical Behavior

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1. Plans and directs activities of classroom assistants including paraprofessionals, volunteers, and tutors. 0 1 2 3 4 5

2. Modifies performance based on personal and professional critiques. 0 1 2 3 4 5

3. Demonstrates flexibility. 0 1 2 3 4 5

4. Demonstrates initiative in planning, management and professional interactions. 0 1 2 3 4 5

5. Maintains confidentiality. 0 1 2 3 4 5

6. Demonstrates effective collaboration in one-to-one and small group interactions. 0 1 2 3 4 5

7. Fosters trust in relationships with students, families and colleagues. 0 1 2 3 4 5

8. Receives and responds to constructive feedback. 0 1 2 3 4 5

Comments:

Q

Summary: ______________________________________ Signature of Evaluator Date ______________________________________________ Signature of Teacher Candidate Date

1000 Regent University Drive

Virginia Beach, VA 23464 (757) 226-4479

R

School of Education

Internship -- Evaluation of Teacher Candidate by School Administrator

Teacher Candidate ________________________________ Date______________________ Semester ________________________________________ School Division___________________________________ School____________________ School Administrator_______________________________ Description of School: 1. Urban ( ) 2. Suburban ( ) 3. Rural ( ) Please rate the teacher candidate on each item using the following scale: E = Excellent S = Satisfactory N = Needs Improvement NA = Not Applicable

E S N NA I. Personal Characteristics and Professional Attitudes

II. Knowledge of Subject Matter III. Planning IV. Instruction V. Management and Control VI. Team Interaction VII. Assessments Areas of Strength: Areas for Refinement: Signature of School Administrator:____________________________________________________ Date:_____________ Signature of Teacher Candidate:________________________________ Date:_____________

S

Semester/Year ___________

Internship -- Clinical Faculty Feedback Please answer the following questions so that we can assess and improve the teacher preparation program at Regent University. Your input is of great value and we plan to take your recommendations into thoughtful consideration as we seek ways to improve our program.

1. Was our teacher candidate adequately prepared for the placement? a) In what areas was the teacher candidate sufficiently prepared? b) In what areas could he/she have been better prepared? 2. Was the university supervisor sufficiently involved in the internship experience? 3. Would you be willing to serve again as a clinical faculty? 4. Do you have any other comments or recommendations? Clinical Faculty Signature____________________________________________________________ Public School:_______________________________________________________________________ Date: __________________ Thank you once again for your time and your input. Please FAX this form (266.4147) to Regent University, School of Education.

T

School of Education

INTERNSHIP -- CLINICAL FACULTY EVALUATION

Teacher Candidate’s Perspective

Clinical Faculty’s Name __________________________________ Semester/Year ___________ Teacher Candidate’s Name ________________________________ Please indicate to what degree your clinical faculty performed the listed activities by circling the appropriate number using the following scale: 4 = Exceeds Expectations 3 = Meets Expectations 2 = Needs Improvement 1 = Unacceptable 0 = Not Observed

I. SUPPORT/COMMUNICATION

• Acquainted you with the school, staff, students, teachers, parents and 4 3 2 1 0 community

• Oriented you to classroom rules, organization, and management 4 3 2 1 0 • Supported you by providing a strong professional relationship with 4 3 2 1 0

you the teacher candidate II. INSTRUCTIONAL GUIDE

• Provided a positive learning environment 4 3 2 1 0 • Provided a desk or work place, necessary instructional materials 4 3 2 1 0

resources, supplies and equipment • Guided you with initial lesson plans and material development 4 3 2 1 0 • Modeled how to maintain grades, lesson plans, and assess students 4 3 2 1 0 • Acquainted you with routine tasks 4 3 2 1 0

III. PROFESSIONAL GROWTH

• Provided opportunities for observation/participation in related school 4 3 2 1 0 events IV. SUPERVISION/ASSESSMENT

• Analyzed and critiqued teaching technique regularly 4 3 2 1 0 • Provided continuous support, conferences, and feedback (written and 4 3 2 1 0

verbal) • Identified specific areas of strength and weakness 4 3 2 1 0

Comments: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please return this form to the School of Education Office / Dr. Wighting.

U

School of Education

INTERNSHIP -- UNIVERSITY SUPERVISOR EVALUATION Teacher Candidate’s Perspective

University Supervisor’s Name __________________________________ Semester/Year ___________ Teacher Candidate’s Name _____________________________________ Please indicate to what degree your university supervisor performed the listed activities by circling the appropriate number using the following scale: 4 = Exceeds Expectations 3 = Meets Expectations 2 = Needs Improvement 1 = Unacceptable 0 = Not Observed I. SUPPORT/COMMUNICATION

• Advised you of the requirements at the beginning of the semester 4 3 2 1 0 • Was accessible by phone and/or email 4 3 2 1 0 • Agreed to visit you when assistance was needed 4 3 2 1 0 • Derived a workable solution if difficulties occurred 4 3 2 1 0 • Provided relevant information through seminars, workshops, 4 3 2 1 0

counseling, etc. • Reviewed weekly journal and provided feedback when needed 4 3 2 1 0 • Discussed development and implementation of lesson plans 4 3 2 1 0 • Reviewed your portfolio and provided feedback on a regular basis 4 3 2 1 0

II. SUPERVISION/ASSESSMENT

• Coordinated visit dates/times with clinical faculty 4 3 2 1 0 • Spent ample time (50-60 minutes) for observation/assessment 4 3 2 1 0 • Analyzed and critiqued teaching technique soon after observation 4 3 2 1 0 • Helped you to identify specific areas of strength and weakness 4 3 2 1 0 • Previewed and discussed the purposes of each evaluation form 4 3 2 1 0 • Reviewed with you the results of each evaluation 4 3 2 1 0 • Conducted a three way conference with teacher candidate intern 4 3 2 1 0

and clinical faculty • Conducted all conferences in a positive and constructive manner 4 3 2 1 0

Number of visits each placement ___________ Comments: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please return this form to the School of Education / Dr. Wighting.

V

School of Education

Elementary Education Licensure Program Internship Time Log

Teacher Candidate's Name _______________________________________________________________ #1 Clinical Faculty's Name/School _________________________________________________________ #2 Clinical Faculty's Name/School _________________________________________________________ Semester/Year ____________________________ Hours

Start Date through End Date Student Contact

Non-Student

Contact

Total

Clinical Faculty's

Signature Week of Week of Week of Week of Week of Week of Week of Week of Week of Week of Week of Week of Week of Week of Week of Week of TOTAL #1 Clinical Faculty's Signature ____________________________________ Date _________________ #2 Clinical Faculty's Signature ____________________________________ Date _________________ Signature of Teacher Candidate ___________________________________ Date _________________

W

School of Education Completion of Internship

Teacher Candidate Name _____________________________________________________ Semester/Year______________________ University Supervisor Name ___________________________________________________ Placement 1 Placement 2 * Mid Term Evaluation □ * Mid Term Evaluation □ * Final Evaluation □ * Final Evaluation □ * Administrator's Evaluation □ * Administrator's Evaluation □ Weekly Journal □ Weekly Journal □ Portfolio □ Portfolio □ * Time Log □ * Time Log □

This teacher candidate has □ Passed □ Failed the Internship.

Signature of University Supervisor: ____________________________________________________ Date: ________________________ * Please attach copies of this form. University Supervisors, please return this form with all attachments to the Field Placement Officer on conclusion of the internship.