NON-TENURED Certified Staff Member Practice Summative Rating/End of Cycle Conference Form
Page 1 of 2
Name of Certified Staff Member: Anna Underhill
Unsatisfactory
Improvement
Name of Evaluator: Chad M. Cox
Proficient
Excellent
Needs
Date of Evaluation: 2/22/2019
DOMAIN 1: Planning and Preparation
1a: Demonstrating knowledge of content and pedagogy OR Specialist 1a X
1b: Demonstrating knowledge of students OR Specialist 1b X
1c: Setting instructional outcomes OR Specialist 1c X
1d-1e: Designing coherent instruction with appropriate resources OR Specialist 1d -1e X
1f: Designing student assessment OR Specialist 1f X
Overall rating for DOMAIN 1 X
DOMAIN 2: Classroom Environment/Environment
2a: Creating an environment of respect and rapport OR Specialist 2a X
2b: Establishing a culture for learning OR Specialist 2b X
2c-2e: Managing classroom procedures and physical environment OR Specialist 2c-2e X
2d: Managing student behavior OR Specialist 2f X
Overall rating for DOMAIN 2 X
DOMAIN 3: Instruction/Delivery of Services
3a: Communicating with students OR Specialist 3a X
3b: Using questioning and discussion techniques OR Specialist 3b X
3c: Engaging students in learning OR Specialist 3c X
3d: Using assessment in instruction OR Specialist 3d X
3e: Demonstrating flexibility and responsiveness OR Specialist 3e X
Overall rating for DOMAIN 3 X
DOMAIN 4: Professional Responsibilities
4a: Reflecting on teaching OR Reflecting on Specialist Practice X
4b: Maintaining Accurate Records X
4c: Communicating with Families/Communities X
4d-4e-4f: Showing Professionalism X
Overall rating for DOMAIN 4 X
NON-TENURED CERTIFIED STAFF MEMBER PRACTICE SUMMATIVE RATING: Proficient
Note: The signature of the Evaluator and NON-TENURED Certified Staff Member verifies that the report has been reviewed. The
employee has the right to submit comments and/or a rebuttal about this report. It is recommended the Certified Staff Member do
this by the end of the year.
NON-TENURED Certified Staff Member Signature & Date: _________________________________________________
Evaluator Signature & Date: _________________________________________________________________________
Peoria Public Schools * 3202 N. Wisconsin Avenue * Peoria, Illinois 61603 * Phone: 309-672-6512 * Email: info@psd150.org 1
NON-TENURED Certified Staff Member Practice Summative Rating/End of Cycle Conference Form
Page 2 of 2
Use the Certified Staff Member’s observation data, planning and reflection conversation data, and Domain 4
documentation to explain that Certified Staff Member’s accomplishments (or strengths) and growth areas. Use the
strengths and growth areas to make recommendations for improvement. When identifying strengths and growth areas,
the Evaluator should cite the applicable domain section being identified.
NON-TENURED Certified Staff Member Name: Anna Underhill Date: 2/22/2019
Accomplishments (strengths): Growth Areas: Recommendations for Improvement:
*Effective, efficient instruction planner *Be constant, consistent positive role *Control what you can control, such as
who works to know the content, know the model and leader within our MS Team attitude and approach in order to stay
students, and set clear goals/outcomes focused on doing what is best for all
for all classes students in all situations
*Strong organization, plans, and clear *Find and implement more ideas on * Work with peers, ELA teachers, district
procedures with students in all classes engaging and interactive activities for staff to find resources and ways to
students increase engaging and interactive
*Strong knowledge of ELA content and activities for students of all abilities/levels
interventions for students who struggle in
reading/writing
*Reflective practitioner who actively
seeks ways to help students succeed;
Works with ELA peers and Read 180 reps
*Serves on building PBIS Team; Takes
initiative and actions with RtI and for
MTSS Team as well
Note: The signature of the Evaluator and Certified Staff Member verifies that the report has been reviewed. The employee has th e
right to submit comments and/or a rebuttal about this report. It is recommended th e Certified Staff Member do this by the end of
the year.
NON-TENURED Certified Staff Member Signature & Date: ________________________________________________
Evaluator Signature & Date: _______________________________________________________________ _______
Peoria Public Schools * 3202 N. Wisconsin Avenue * Peoria, Illinois 61603 * Phone: 309-672-6512 * Email: info@psd150.org 2
