Formative Teacher/educational speciaList evaluation permanent teachers/specialists

District Name:	Click here to enter text.

Date:	Click here to enter text.

TEACHER/SPECIALIST INFORMATION

Teacher/Specialist Name	Click here to enter text.	Grade/Subject:	Click here to enter text.

School(s)	1. Click here to enter text.	Evaluator:	Click here to enter text.

2. Click here to enter text.	School Year:	Click here to enter text.

3. Click here to enter text.	Date of Evaluation:	Click here to enter text.

☐ Formative Year One

☐ Formative Year Two

Part I: Nebraska Effective Practices. During formative evaluation years no ratings are given for the Effective Practices. However, evaluator comments based on informal and walk-through observations can be made.
EFFECTIVE PRACTICE 1 - Foundational Knowledge EFFECTIVE PRACTICE 2 - Planning and Preparation EFFECTIVE PRACTICE 3 - The Learning Environment EFFECTIVE PRACTICE 4 - Instructional Strategies EFFECTIVE PRACTICE 5 - Assessment EFFECTIVE PRACTICE 6 - Professionalism EFFECTIVE PRACTICE 7 - Vision and Collaboration

Evaluator’s Comments
Areas of Strength
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Areas for Development
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Additional Comments
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Part II: Student Learning Objectives/Specialist Program Objectives. (Combined rating; attach SLO/SPO Templates)
Evaluator Rating	Description
☐ Exemplary	Results across all Student Learning Objectives/Specialist Program Objectives demonstrate that objectives have been met or exceeded in all respects. Students, including those in special populations, show exceptional learning gains, or program elements improved at a level beyond expectations. SLO/SPO design shows exemplary quality and rigor and implementation strategies were executed diligently. The teacher/educational specialist's impact on student learning or program improvement can serve as a model for other faculty.
☐ Proficient	Results across all Student Learning Objectives/Specialist Program Objectives demonstrate that objectives have been met or nearly met on an overall basis, and all or nearly all students or program criteria show growth. Special populations show significant learning gains, or program elements improved at the expected level. SLO/SPO design shows appropriate quality and rigor and implementation strategies were effectively carried out. The teacher/educational specialist's impact on student learning or program improvement is evident.
☐ Basic	Results across all Student Learning Objectives/Specialist Program Objectives demonstrate that objectives have not been met on an overall basis, although some student achievement growth or program criteria improvement is evident. Growth in student achievement or program improvement is somewhat below expectations. SLO/SPO design may have been somewhat lacking in quality and /or rigor and implementation strategies were not carried out as effectively as could be expected.
☐ Unsatisfactory	Results across all Student Learning Objectives/Specialist Program Objectives demonstrate that objectives were not met or met only partially, and student achievement growth or program improvement is significantly below expectations. In addition, SLO/SPO design may have been deficient in quality and/or rigor and implementation strategies were not effectively carried out.
Evaluator’s Comments
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☐	Plan for Improvement attached (required for rating of “Basic”)

☐	Plan for Assistance attached (required for rating for rating of “Unsatisfactory”)

Part III: Individual Professional Development Plan. (Attach plan)
Evaluator Rating	Description
☐ Exemplary	The Individual Professional Development Plan's goals have been met or exceeded in all respects. There is evidence that implementation and completion of the Plan has led to significant, positive, and lasting change in job performance.
☐ Proficient	The Individual Professional Development Plan's goals have been met or nearly met on an overall basis. There is evidence that implementation and completion of the Plan has led to a positive change in job performance.
☐ Basic	The Individual Professional Development Plan's goals have not been met or have been only partially met on an overall basis. There is limited evidence to date that implementation of the Plan has led to a positive change in job performance.
☐ Unsatisfactory	The Individual Professional Development Plan's goals have not been met to a satisfactory degree. Implementation of the Plan has not led to a positive change in job performance.
Evaluator’s Comments
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☐	Plan for Improvement attached (required for rating of “Basic”)

☐	Plan for Assistance attached (required for rating for “Unsatisfactory”)

Part IV: Local District Standards (Optional)
Local District Standards	Meets District Standards
Click here to enter text.	☐ Yes	☐ No
Click here to enter text.	☐ Yes	☐ No
Click here to enter text.	☐ Yes	☐ No
Click here to enter text.	☐ Yes	☐ No

Overall Rating for Local District Standards Meets Districts Standards
☐ Yes	☐ No
Evaluator’ Comments
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Part V: Overall Evaluator Comments: There is no overall rating during the formative evaluation years, but space for evaluator comments is provided.
Areas of Strength
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Areas for Development
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Additional Comments
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Evaluator Signature:	______________________________________________________

Date: __________________

Teacher/Specialist Signature:	______________________________________________________

Date: ___________________

My signature certifies that the evaluation results have been discussed with me. I understand my signature does not necessarily indicate agreement and that I may respond in writing to any issues contained in the evaluation.

Part VI: Attachments (attach the following items)

Record of Evaluation Activities

Annual Self-Assessment (Optional)

Classroom Observation Summaries

Student Learning Objectives/Specialist Program Objectives Templates

Individual Professional Development Plan

Plan for Improvement (if any)

Plan of Assistance (if any)

Part VII: Record of Evaluation Activities (Permanent Teacher/Specialist)
Activity	Date	Principal/Administrator Signature	Evaluator Signature
Orientation
Annual Self-Assessment Completed and Submitted (Optional)
Student Learning Objectives/Specialist Program Objectives Approval
Individual Professional Development Plan Approval
Dates of Observation
Informal/Walk-Through Observations
1.
2.
3.
4.
5.
Dates of Observation Conferences
1.
2.
3.
4.
5.
SLO/SPO Review Conference
SLP/SPO Summative Conference
IPD Plan Review Conference
IDP Plan Summative Conference
Formative Evaluation Conference