Summative Assessment Form

Name Date:
:

I.A.1: Subject Matter Knowledge

Unsatisfactory Needs Improvement Proficient Exemplary
Demonstrates limited Demonstrates factual Demonstrates sound Demonstrates expertise
knowledge of the knowledge of subject knowledge and in subject matter and the
subject matter and/or matter and the understanding of the pedagogy it requires by
its pedagogy; relies pedagogy it requires subject matter and consistently engaging all
heavily on textbooks by sometimes the pedagogy it students in learning
or resources for engaging students in requires by experiences that enable
development of the learning experiences consistently engaging them to acquire,
I-A-1. factual content. that enable them to students in learning synthesize, and apply
Subject Rarely engages acquire complex experiences that complex knowledge and
Matter students in learning knowledge and enable them to subject-specific skills and
Knowledge experiences focused subject-specific skills acquire complex vocabulary, such that
on complex and vocabulary. knowledge and they are able to make
knowledge or subject- subject-specific skills and assess evidence-
specific skills and and vocabulary, such based claims and
vocabulary. that they are able to arguments. Models this
make and assess practice for others.
evidence-based
claims and
arguments.
Quality *
Scope *
Consistency *

Sources of Evidence for I.A.1: Subject Matter Knowledge:

#1 #1 #2 #2
Observations Announced Unannounced Announced Unannounced
 Req.  Req.  

Measure of Student
Student Feedback Candidate Artifacts Professional Practice Goal
Learning
 Req.   

Evidence [insert evidence to support the ratings here]:

 I.A.3: Well-Structured Units and Lessons
Unsatisfactory Needs Improvement Proficient Exemplary
Delivers individual Implements lessons Adapts as needed Adapts as needed and
lessons rather than and units of and implements implements standards-
units of instruction; instruction to address standards-based based units comprised of
constructs units of some knowledge and units comprised of well-structured lessons
instruction that are skills defined in state well-structured with challenging tasks
not aligned with state standards/local lessons with and measurable
standards/local curricula with some challenging tasks and outcomes; appropriate
curricula and/or elements of measurable student engagement
designs lessons that appropriate student outcomes; strategies, pacing,
I-A-3. lack measurable engagement appropriate student sequence, resources,
outcomes, fail to strategies, but some engagement and grouping;
Well-
include appropriate student outcomes are strategies, pacing, purposeful questioning;
Structured
student engagement poorly defined and/or sequence, resources, and strategic use of
Units and
strategies, and/or tasks are not and grouping; technology and digital
Lessons
include tasks that challenging. purposeful media; such that all
mostly rely on lower questioning; and students are able to
level thinking skills. strategic use of learn and apply in
technology and authentic contexts the
digital media; such knowledge and skills
that students are defined in state
able to learn the standards/local
knowledge and skills curricula. Models this
defined in state practice for others.
standards/local
curricula.
Quality *
Scope *
Consistency *

Sources of Evidence for I.A.3: Well-Structured Units and Lessons:

#1 #1 #2 #2
Observations Announced Unannounced Announced Unannounced
 Req.  Req.  

Measure of Student
Student Feedback Candidate Artifacts Professional Practice Goal
Learning
 Req.   

Evidence [insert evidence to support the ratings here]:

 I.B.2: Adjustments to Practice
Unsatisfactory Needs Improvement Proficient Exemplary
Makes few May analyze some Analyzes results from a Regularly organizes and
adjustments to assessment results variety of assessments analyzes results from a
practice based on but only occasionally to determine progress variety of assessments
formal and informal adjusts practice or toward intended to determine progress
assessments. modifies future outcomes and uses toward intended
instruction based on these findings to adjust outcomes and uses
the findings. practice and identify these findings to adjust
and/or implement practice in real-time
differentiated and in upcoming
I-B-2. interventions and lessons or units by (a)
Adjustments enhancements for identifying and/or
to Practice students. implementing
appropriate
differentiated
interventions and
enhancements for all
students, and (b)
making appropriate
modifications to
lessons and units.
Models this practice for
others.
Quality *
Scope *
Consistency *

Sources of Evidence for I.B.2: Adjustments to Practice:

#1 #1 #2 #2
Observations Announced Unannounced Announced Unannounced
   Req.  Req.

Measure of Student
Student Feedback Candidate Artifacts Professional Practice Goal
Learning
 Req.   

Evidence [insert evidence to support the ratings here]:

 II.A.3: Meeting Diverse Needs
Unsatisfactory Needs Improvement Proficient Exemplary
Uses limited and/or May use some Uses appropriate Uses a variety of
inappropriate appropriate practices inclusive practices, appropriate inclusive
practices to to accommodate such as tiered practices, such as
accommodate differences, but fails supports and tiered supports and
differences. to address an scaffolded scaffolded
adequate range of instruction, to instruction, to
differences. accommodate address specific
differences in differences in
students’ learning individual students’
II-A-3. needs, abilities, learning needs,
Meeting interests, and levels abilities, interests,
Diverse of readiness, and levels of
Needs including those of readiness, creating
academically structured
advanced students, opportunities for
students with each student to meet
disabilities, and or exceed state
English learners. standards/local
curriculum and
behavioral
expectations. Models
this practice for
others.
Quality *
Scope *
Consistency *

Sources of Evidence for II.A.3: Meeting Diverse Needs:

#1 #1 #2 #2
Observations Announced Unannounced Announced Unannounced
  Req.  

Measure of Student Professional Practice

Student Feedback Candidate Artifacts
Learning Goal
 Req.   

Evidence [insert evidence to support the ratings here]:

 II.B.1: Safe Learning Environment
Unsatisfactory Needs Improvement Proficient Exemplary

Maintains a physical May create and Uses rituals, routines, Uses rituals, routines,
environment that is maintain a safe physical and appropriate and proactive responses
unsafe or does not environment but responses that create that create and
support student inconsistently maintains and maintain a safe maintain a safe physical
II-B-1. learning. Uses rituals, routines, and physical and intellectual and intellectual
Safe inappropriate or responses needed to environment where environment where
Learning ineffective rituals, prevent and/or stop students take academic students take academic
Environment routines, and/or behaviors that interfere risks and most risks and play an active
responses to reinforce with all students’ behaviors that interfere role—individually and
positive behavior or learning. with learning are collectively—in
respond to behaviors prevented. preventing behaviors
that interfere with that interfere with
students’ learning. learning. Models this
practice for others.
Quality *
Scope *
Consistency *

Sources of Evidence for II.B.1: Safe Learning Environment:

#1 #1 #2 #2
Observations Announced Unannounced Announced Unannounced
.  Req.  

Measure of Student
Student Feedback Candidate Artifacts Professional Practice Goal
Learning
.  Req.  

Evidence [insert evidence to support the ratings here]:

 II.E.1: High Expectations
Unsatisfactory Needs Improvement Proficient Exemplary

Does not Occasionally Clearly communicates Effectively

communicate communicates high standards for communicates
specific academic expectations for student work, effort, high standards for
and behavior student work, effort, and behavior, and student work,
expectations to and behavior in the consistently effort, and
students, and gives classroom, but reinforces the behavior such that
up on some students inconsistently expectation that all students take
or communicates enforces these students can meet ownership of
II-E-1. that some cannot expectations and/or these standards meeting them;
High master challenging does little to through effective models and
Expectations material. counteract student effort, rather than reinforces ways
misconceptions about innate ability. that students can
innate ability. master challenging
material through
effective effort,
and successfully
challenges
misconceptions
about innate
ability. Models this
practice for others.
Quality *
Scope *
Consistency *

Sources of Evidence for II.E.1: High Expectations:

#1 #1 #2 #2
Observations Announced Unannounced Announced Unannounced
 Req.   

Measure of Student
Student Feedback Candidate Artifacts Professional Practice Goal
Learning
  Req.  

Evidence [insert evidence to support the ratings here]:

 IV.A.1: Reflective Practice
Unsatisfactory Needs Improvement Proficient Exemplary

Demonstrates May reflect on the Regularly reflects on Regularly reflects on

limited reflection on effectiveness of the effectiveness of the effectiveness of
practice and/or use lessons/ units and lessons, units, and lessons, units, and
of insights gained to interactions with interactions with interactions with
IV-A-1.
improve practice. students by oneself, students, both students, both
Reflective but not with individually and with individually and with
Practice colleagues and/or colleagues, and uses colleagues; uses and
rarely uses insights to insights gained to shares back with
improve practice. improve practice and colleagues’ insights
student learning. gained to improve
practice and student
learning.
Quality *
Scope *
Consistency *

Sources of Evidence for IV.A.1: Reflective Practice:

#1 #1 #2 #2
Observations Announced Unannounced Announced Unannounced
   

Measure of Student
Student Feedback Candidate Artifacts Professional Practice Goal
Learning
 Req.  Req.  Req.  Req.

Evidence [insert evidence to support the ratings here]:

Summative Assessment – Calibration

Summary of Ratings
Readiness Thresholds
Element Quality Scope Consistency
Met? (Y/N)
1.A.1: Subject Matter Knowledge
1.A.3: Well-Structured Units and
Lessons
1.B.2: Adjustments to Practice
2.A.3: Meeting Diverse Needs
2.B.1: Safe Learning Environment
2.E.1: High Expectations
4.A.1: Reflective Practice

Evidence-Based Feedback to
Candidate

Recommended Focus for

Future Professional Practice
Goal