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

Date:	Click here to enter text.

TEACHER SECTION

Population: Describe the student population and any special learning circumstances.
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Subject/Content: Describe the content to be addressed the SLO
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Baseline Data: Describe the students’ current levels of performance in this subject/content.
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Student Learning Objective: In specific and measurable terms, describe what you want students to achieve by the end of the learning interval. State whether the SLO is based on growth or mastery.
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Growth Targets/Tiered Growth Targets: For SLOs based on growth, state the expected amount of growth for the learning interval either for all students or for each tier of students. For mastery SLOs, state number/percent of students expected to achieve mastery by end of the learning interval.
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Learning Interval:
☐ Year
☐ Semester
☐ Other ______________________

Instructional Strategies: Describe strategies you will use to achieve the Student Learning Objective.
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Assessment Plan: Describe the assessment(s) you will use to determine whether students have met the objective.
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Rational: Explain why you have chosen this particular objective.
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Teacher Signature: ____________________________________________

EVALUATOR SECTION

Date: Click here to enter text.

Approval of Objectives
Important Content	☐ Unacceptable	☐ Acceptable
Rigor of Objective/Target	☐ Unacceptable	☐ Acceptable
Quality of Assessment Plan	☐ Unacceptable	☐ Acceptable
☐ Approved	☐ Returned for Review

Mid-Interval Review: Describe progress on SLO, suggestion, comments.
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Individual SLO End-of-Month Review: (Attach completed rubric)
Quality and Rigor of the Objective/Targets
☐ Unsatisfactory	☐ Basic	☐ Proficient	☐ Exemplary
Effectiveness in Implementing the Planned Strategies
☐ Unsatisfactory	☐ Basic	☐ Proficient	☐ Exemplary
Accomplishment of the SLO goals
☐ Unsatisfactory	☐ Basic	☐ Proficient	☐ Exemplary
Comments:
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Evaluator Signature: ____________________________________________ Date: _____________________

Teacher Signature: ____________________________________________	Date: _____________________