Intern’s Name: _____________________________________________ Observation Date: ___________________ Observer’s Name: _______________________________

Element Requires Action Progressing (1 or 2 points) Accomplished (3 or 4 points) Exemplary (5 points)

1a The PST’s plans and The PST’s plans and practice reflect The PST’s plans and practice reflect The PST’s plans and practice reflect
Demonstrating practice display little some awareness of the important solid knowledge of the content, extensive knowledge of content,
Knowledge of knowledge of the content, concepts in the discipline, prerequisite prerequisite relationships between instructional practices, and the structure
Content and relationships between relationships between them, and the important concepts, and the of the discipline. The PST uses knowledge
Pedagogy different aspects of the instructional practices specific to that instructional practices specific to of content sequence and misconceptions
content, or the discipline. that discipline. when describing and planning instruction.
Score instructional practices The PST stays abreast of new and
specific to that discipline. innovative methods and incorporates into
_______ plans and instructional strategies.
1b PST demonstrates little or no knowledge PST indicates the importance of PST actively seeks knowledge of The PST actively seeks knowledge of
Knowledge of of students’ backgrounds, cultures, skills, understanding students’ backgrounds, students’ backgrounds, cultures, skills, students’ backgrounds, cultures, skills,
Students learning levels/styles, language cultures, skills, learning levels/styles, learning levels/styles, language learning levels/styles, language proficiencies,
proficiencies, interests, & special needs, language proficiencies, interests, & proficiencies, interests, & special interests, and special needs from a variety of
Score & does not seek understanding when special needs, & attains this knowledge needs, & attains this knowledge for sources, and attains this knowledge of
planning instructional activities & for the class as a whole when planning groups of students when planning individual students when planning
_______ selecting resources. instructional activities & selecting instructional activities & selecting instructional activities and selecting
resources & strategies. resources & strategies. resources and strategies.
1c Instructional outcomes reflected in lesson Instructional outcomes reflected in lesson Instructional outcomes reflected in Instructional outcomes reflected in lesson
Setting design are unsuitable for students, design are of moderate rigor and are lesson design are stated as goals design are stated as goals that can be
Instructional represent low-level learning, or are suitable for some students, but consist of reflecting high-level learning and assessed, reflecting rigorous learning and
Outcomes stated only as activities. They do not a combination of activities and goals, curriculum standards. Outcomes are curriculum standards. They represent
permit viable methods of assessment. some of which permit viable methods of suitable for most students in the class, different types of content, offer
Score The PST develops general student assessment. Outcomes reflect more than represent different types of learning, opportunities for integration, and take
achievement goals for the class OR does one type of learning, but plans and and can be assessed. The PST develops account of the needs of individual students.
_______ not develop a goal at all. practice do not reflect coordination or measurable student achievement The PST develops ambitious and measurable
integration. The PST develops goals for the class that are aligned to student achievement goals for the class that
measurable student achievement goals content standards and evident in both are aligned to the content standards and
for the class plans and practice. evident in both plans and practice.
1d PST demonstrates little or no familiarity PST demonstrates some familiarity with PST’s plans reflect awareness of the PST’s plans and practice incorporate
Knowledge of with resources and/or technology to resources & technology available through resources and technology available resources and technology (as available) in
Resources & enhance own knowledge, to use in the school or district to enhance own through the school or district to and beyond the school or district in
Technology designing instruction or provide for knowledge, to use in designing enhance own knowledge, to use in professional organizations, on the Internet,
students in order to enhance learning. instruction or provide for students in designing instruction or provide for and in the community to enhance own
Score order to enhance learning. students in order to enhance learning. knowledge, to use in designing instruction to
_______ enhance student learning.
1e The series of learning experiences is The series of learning experiences The PST coordinates knowledge of The PST coordinates knowledge of content,
Designing poorly aligned with the instructional demonstrates partial alignment with content, students, and resources to students, and resources to design a series of
Coherent outcomes & does not represent a instructional outcomes; some design a series of learning experiences learning experiences aligned to instructional
Instruction coherent structure. The experiences are experiences are likely to engage students aligned to instructional outcomes and outcomes, differentiated (where
suitable for only some students. in significant learning. The lesson/unit suitable for groups of students. The appropriate) for all students, and likely to
Score The PST does not plan lessons/units by has a recognizable structure and reflects lesson/unit has a clear structure and is engage them in significant learning. The
identifying the content standards that his partial knowledge of students and likely to engage students in significant lesson/unit structure is clear and allows for
_______ or her students will master in each unit resources. Based on the annual student learning. Based on the annual student different pathways according to student
OR does not articulate well-designed achievement goal, the PST plans achievement goal, the PST plans needs. Based on the annual student
essential questions for each unit. lessons/units using 2 of the 4 practices: 1) lessons/units using 3 of the 4 achievement goal, the PST plans
identifying the content standards practices: 1) identifying the content lessons/units using 4 practices: 1) identifying
students will master; 2) articulating well- standards that students will master; 2) the content standards students will master;

Assessment procedures are not
1f congruent with instructional outcomes;
Designing the proposed approach contains no
Student criteria or standards. PST has no plan to
Assessments incorporate formative assessment in the
lesson or unit, nor any plans to use
Score assessment results in designing future
instruction.
_______
Evidence and Next Steps:
designed essential questions; 3)
employing backward design; and 4)
allocating an instructionally appropriate
amount of time.
Assessment criteria and standards have
been developed but are unclear.
Approach to the use of formative
assessment is rudimentary, including only
some of the instructional outcomes. The
PST intends to use assessment results to
plan for future instruction for the class as
a whole.
articulating well-designed essential
questions; 3) employing backward
design; and 4) allocating an
instructionally appropriate amount of
time.
The PST's plan for student assessment
is aligned with the instructional
outcomes; assessment methodologies
may have been adapted for groups of
students. Assessment criteria and
standards are clear. The PST has a
well-developed strategy for using
formative assessment within the
lesson and has designed particular
approaches to be used. The PST
intends to use assessment results to
plan for future instruction for groups
of students.
2) articulating well-designed essential
questions; 3) employing backward design;
and 4) allocating an instructionally
appropriate amount of time.
The PST's plan for student assessment is
fully aligned with the instructional
outcomes, with clear criteria and standards
that show evidence of student contribution
to their development. Assessment
methodologies have been adapted for
individual students, as needed. The
approach to using formative assessment is
well designed and includes student as well
as PST use of the assessment information.
The PST intends to use assessment results to
plan future instruction for individual
students.
 Domain 2: The Classroom Environment

Element Requires Action Progressing (1 or 2 points) Accomplished (3 or 4 points) Exemplary (5 points)

2a Classroom interactions, between the PST Classroom interactions, between the PST Classroom interactions between the PST Classroom interactions among the PST and
Creating an and students and/or among students, are and students and among students, are and students and among students are individual students are respectful,
Environment negative, inappropriate, or insensitive to generally appropriate and free from polite and respectful, reflecting general reflecting genuine warmth and caring and
of Respect students’ cultural backgrounds and are conflict, but may be characterized by warmth and caring, and are appropriate to sensitivity to students’ cultures and levels
and Rapport characterized by sarcasm, put-downs, or occasional behaviors and/or language that the cultural and developmental of development. Students themselves
conflict. compromise the promotion of learning. differences among groups of students. ensure high levels of civility among
Score members of the class.

_______

2b The classroom environment conveys a
Establishing negative culture for learning,
a Culture for characterized by low PST commitment to
Learning the importance and relevancy of learning
goals of the lesson, low expectations for
Score student achievement, little or no student
pride in work and no evidence that
_______ students believe that they can succeed if
they work hard.
The PST’s attempt to create a culture for
learning is partially successful, with
moderate PST commitment to the
importance and relevancy of learning
goals of the lesson, some evidence that
students are committed to success
beyond completion of assignments,
modest expectations for student
achievement, and little student pride in
work.
The classroom culture is characterized by
high expectations for most students, the
belief that students can succeed if they
work hard, and genuine commitment to
the subject by both PST and students, with
students demonstrating pride in their
work.
High levels of student energy and PST
passion for the subject create a culture of
learning in which everyone shares a belief
in the importance of the subject and the
belief that students can succeed if they
work hard. All students hold themselves to
high standards of performance—for
example, by initiating improvements to
their work.

2c Much instructional time is lost because of Some instructional time is lost because Little instructional time is lost because of Students contribute without prompting to
Managing inefficient classroom routines and classroom routines and procedures for classroom routines and procedures for the seamless operation of classroom
Classroom procedures for transitions, handling of transitions, handling of supplies, and transitions, handling of supplies, and routines and procedures for transitions,
Procedures supplies, and performance of non- performance of non-instructional duties performance of non-instructional duties, handling of supplies, and performance of
instructional duties. are only partially effective. which occur smoothly. Students willingly non-instructional duties.
Score assist with procedures when asked.

_______

There is no evidence that standards of
2d conduct have been established and little
Managing or no PST monitoring of student behavior.
Student Response to student misbehavior is
Behavior repressive or disrespectful of student
dignity.
Score The PST does not reinforce positive
behavior. The PST does not address off-
_______ task, inappropriate, or challenging
behavior efficiently. Inappropriate and off-
task student behavior has significant
negative impact on the learning of
students in the class.
It appears that the PST has made an effort
to establish standards of conduct for
students and tries to monitor student
behavior and respond to student
misbehavior, but these efforts are not
always successful.
The PST reinforces positive behavior. The
PST addresses some off-task,
inappropriate, or challenging behavior
efficiently. Inappropriate and off-task
student behavior has some negative
impact on the learning of students in the
class.
Standards of conduct appear to be clear to
students, and the PST monitors student
behavior against those standards. The
PST’s response to student misbehavior is
appropriate and respectful to students.
The PST strategically reinforces positive
behavior. The PST addresses most off-
task, inappropriate, or challenging
behavior efficiently. Inappropriate and off-
task student behavior has little negative
impact on the learning of students in the
class.
Standards of conduct are clear, with
evidence of student participation in
setting them. The PST’s monitoring of
student behavior is subtle, preventive, and
responses to student misbehavior are
sensitive to individual student needs.
Students actively monitor the standards of
behavior. The PST strategically reinforces
positive behavior AND there is significant
evidence that students reinforce positive
classroom culture. The PST addresses
almost all off-task, inappropriate, or
challenging behavior efficiently.
Inappropriate and off-task behavior has
no negative impact on student learning.
 2e The physical environment is unsafe, or The classroom is safe, and essential The classroom is safe, and learning is The classroom is safe, and the physical
Organizing many students don’t have access to learning is accessible to most students. accessible to all students; the PST ensures environment ensures the learning of all
Physical learning. Alignment between the physical The PST may attempt to modify the that the physical arrangement supports students, including those with special
Space arrangement and the lesson activities is physical arrangement to suit learning the learning activities. The PST makes needs. Students contribute to the use or
poor. activities with partial success. effective use of physical resources. adaptation of the physical environment to
Score advance learning. The PST uses technology
skillfully, as appropriate to the lesson.
_______

Evidence and Next Steps:


Element Requires Action
The purpose and relevancy of the
lesson’s instructional outcomes are
unclear to students and the directions
and procedures are confusing. The PST's
3a explanation of the content contains
Communicating major errors. The PST's spoken or written
with Students language contains errors of grammar or
syntax. Vocabulary is inappropriate,
Score vague, or used incorrectly, leaving
students confused.
_______
3b The PST's questions are of low cognitive
Using challenge, asking for single correct
Questioning responses, and/or are asked in rapid
and Discussion succession. Interactions between PST and
Techniques students are predominately recitation
style with the PST mediating all questions
Score and answers. A few students dominate
the discussion.
_______
3c The learning tasks and activities,
Engaging materials, resources, instructional groups
Students in and/or technology are poorly aligned
Learning with the instructional outcomes, or
require only rote responses. The pace of
Score the lesson is too slow or rushed. Few
students are intellectually engaged or
_______ interested.
Domain 3: Instruction
Progressing (1 or 2 points)
The PST's attempt to explain the purpose
and relevancy of the lesson’s
instructional outcomes has only limited
success, and/or directions and
procedures must be clarified after initial
student confusion. The PST's explanation
of the content may contain minor errors;
some portions are clear; other portions
are difficult to follow. The PST's
explanation may consist of a monologue,
with no invitation to the students for
intellectual engagement. The PST's
spoken language is correct; however,
vocabulary is limited or not fully
appropriate to the students' ages and/or
backgrounds.
The PST's questions lead students
through a single path of inquiry, with
answers seemingly determined in
advance. Alternatively, the PST attempts
to frame some questions designed to
promote student thinking and
understanding, but only a few students
are involved.
The learning tasks or prompts are
partially aligned with the instructional
outcomes but require only minimal
thinking by students, allowing most
students to be passive or merely
compliant. Learning activities are not
sufficiently challenging and lack the rigor
to promote intellectual engagement. The
pacing of the lesson may not provide
students the time needed to be
intellectually engaged.
Accomplished (3 or 4 points)
The purpose and relevancy of the
lesson’s instructional outcomes are
clearly communicated to students,
including where it is situated within
broader learning; directions and
procedures are explained clearly. The
PST's explanation of content is well
scaffolded, clear and accurate, and
connects with students' knowledge and
experience. During the explanation of
content, the PST invites student
intellectual engagement. The PST's
spoken and written language is clear and
correct. Vocabulary is appropriate to the
students' ages and interests.
While the PST may use some low-level
questions, he/she poses questions to
students designed to promote student
thinking and understanding. The PST
creates a genuine discussion among
students, providing adequate time for
students to respond, and stepping aside
when appropriate. The PST successfully
engages most students in the discussion,
employing a range of strategies to ensure
that most students are heard.
The learning tasks and activities are
aligned with the instructional outcomes
and are designed to challenge student
thinking, resulting in active intellectual
engagement by most students with
important and challenging content, and
with PST scaffolding to support that
engagement. The pacing of the lesson is
appropriate, providing most students the
time needed to be intellectually engaged.
Exemplary (5 points)
The PST links the purpose and relevancy
of the lesson’s instructional outcomes to
students' interests; the directions and
procedures are clear and anticipate
possible student misunderstanding. The
PST's explanation of content is thorough
and clear, developing conceptual
understanding through artful scaffolding
and connecting with students' interests.
The students contribute to extending the
content, and in explaining concepts to
their classmates. The PST's spoken and
written language is expressive, and the
PST finds opportunities to extend
students' vocabularies.
The PST uses a variety or series of
questions or prompts to challenge
students cognitively, advance high level
thinking and discourse, and promote
meta-cognition. The students formulate
many questions, initiate topics and make
unsolicited contributions. The students
themselves ensure that all voices are
heard in the discussion.
Virtually all students are intellectually
engaged in challenging content, through
well-designed learning tasks, and suitable
scaffolding by the PST, and fully aligned
with the instructional outcomes. There is
evidence of some student initiation of
inquiry, and student contributions to the
exploration of important content. The
pacing of the lesson provides students
the time needed to intellectually engage
with and reflect upon their learning and
to consolidate their understanding.
Students may have some choice in how
they complete tasks and may serve as
resources for one another.
 3d Assessment is not used in instruction, Assessment is occasionally used in Assessment is regularly used in Assessment is fully integrated in a
Using either through monitoring of progress by instruction, through some monitoring of instruction, through self-assessment by sophisticated manner in instruction
Assessment in the PST or students, or through feedback progress of learning by PST and/or students, monitoring of progress of through student involvement in
Instruction to students; students are unaware of the students. Feedback to students is learning by the PST and/or students, and establishing the assessment criteria, self-
assessment criteria used to evaluate their uneven, and students are aware of only high-quality feedback to students. assessment by students, monitoring of
Score work. some of the assessment criteria used to Students are fully aware of the progress by both students and PSTs, and
evaluate their work. assessment criteria used to evaluate their high-quality feedback to students from a
_______ work. variety of sources. Formative
assessments provide students with
multiple ways and multiple opportunities
during the unit to demonstrate mastery
and are woven into the lesson in a
seamless fashion.

3e The PST adheres to the instruction plan, The PST attempts to modify the lesson The PST promotes the successful learning The PST seizes an opportunity to enhance
Demonstrating even when a change would improve the when needed and to respond to student of all students, making adjustments as learning, building on a spontaneous
Flexibility and lesson or address students’ needs. The questions with moderate success; needed to instruction plans and event or student interests. The PST
Responsiveness PST brushes aside student questions; however, alternate instructional accommodating student questions, ensures the success of all students, using
strategies are limited and minimally needs, and interests. an extensive repertoire of instructional
Score successful. strategies. In response to student
progress data, the PST 1) re-teaches, as
_______ appropriate, 2) modifies long-term plans,
as appropriate, and 3) modifies practice,
as appropriate.

Evidence and Next Steps:

 Domain 4: Professional Responsibilities

Element Requires Action Progressing (1 or 2 points) Accomplished (3 or 4 points) Exemplary (5 points)

4a The PST does not accurately assess the The PST provides a partially accurate and The PST provides an accurate and The PST’s reflection on the lesson is
Reflecting on effectiveness of the lesson and has no objective description of the lesson but objective description of the lesson, citing thoughtful and accurate, citing specific
Teaching ideas about how the lesson could be does not cite specific evidence. The PST specific evidence. The PST makes some evidence. The PST draws on an extensive
improved. makes only general suggestions as to how specific suggestions as to how the lesson repertoire to suggest alternative
Score the lesson might be improved. might be improved. strategies and predicts the likely success
of each.
_______

4b The PST’s systems for maintaining both The PST’s system for maintaining both The PST’s systems for maintaining both The PST’s systems for maintaining both
Maintaining instructional and non-instructional instructional and non-instructional instructional and non-instructional instructional and non-instructional
Accurate records are either nonexistent or in records is rudimentary and only partially records are accurate, efficient, and records are accurate, efficient, and
Records disarray, resulting in errors and effective. effective. effective. Students contribute to the
confusion. maintenance of these systems.
Score
_______
4c The PST’s communication with The PST adheres to school procedures for The PST communicates frequently with The PST’s communication with
Communicating stakeholders about the instructional communicating with stakeholders and stakeholders and successfully engages stakeholders is frequent and sensitive to
With program or about individual students is makes modest attempts to engage them in the instructional program. cultural traditions; students participate in
Stakeholders sporadic or culturally inappropriate. The families in the instructional program. Information to families about individual the communication. The PST successfully
PST makes no attempt to engage families However, communications are not always students is conveyed in a culturally engages families in the instructional
Score in the instructional program. appropriate to the cultures of those appropriate manner. program as appropriate.
families.
_______
4d The PST avoids participating in a The PST becomes involved in the The PST participates actively in the The PST makes a substantial contribution
Participating in professional community or in school and professional community and in school professional community and in school to the professional community and to
a Professional district events and projects; rarely and district events and projects when and district events and projects, actively school and district events and projects,
Community collaborates with colleagues; and specifically asked, makes some effort to seeks out opportunities to collaborate collaborates with / coaches others
relationships with colleagues are negative collaborate with colleagues, and with others, and maintains positive and through difficult situations, and assumes
Score or self-serving. relationships with colleagues are cordial. productive relationships with colleagues. a leadership role among the faculty.

_______
4e The PST does not participate in The PST participates in professional The PST seeks out opportunities for The PST actively pursues professional
Growing and professional development activities and development activities that are professional development based on an development opportunities and initiates
Developing makes no effort to share knowledge with convenient or are required and makes individual assessment of needs and activities to contribute to the profession.
Professionally colleagues. The PST is resistant to some contributions to the profession. The actively shares expertise with others. The In addition, the PST seeks feedback from
feedback from supervisors or colleagues. PST accepts, feedback from supervisors PST welcomes feedback from supervisors supervisors and colleagues.
Score and colleagues. and colleagues.

_______

4f The PST inconsistently adheres to The PST strives to adhere to standards for The PST consistently adheres to and The PST consistently adheres to standards
Showing standards for professional conduct and professional conduct and overall models standards for professional for professional conduct and overall
professionalism overall performance requirements, performance requirements, including conduct and overall performance performance; including attendance and
including attendance and punctuality. attendance and punctuality. requirements, including attendance and punctuality. The PST complies fully and
Score punctuality. voluntarily with school and district
 regulations. The PST helps members of
_______ school community understand and
adhere to these professional obligations.
He or she actively seeks, responds well to
and acts upon feedback. Stakeholders are
aware that the PST models the values of
respect, honesty and integrity. The PST
works cooperatively with school staff and
actively encourages colleagues to do so.
Evidence and Next Steps:

Signature of Observer: _________________________________________________________________

Signature of Intern: ___________________________________________________________________