ASelf-ReflectionshouldbecompletedinconjunctionwiththeappropriateEvaluationRubricsbasedonthe roleoftheeducatorcompletingtheSelf-Reflection(EX:Teacher,SchoolLeader,orCounselor).

Educator’sName
Program Type
Location
County
Evaluator’sName
Date
Time / Start / End
FFL Levels Served: Check all that apply
ABE Federal Functioning Levels (FFL)
☐ Beginning Literacy
☐ Beginning Basic Education
☐ Low Intermediate Basic Education
☐ High Intermediate Basic Education
☐ Low Adult Secondary Education
☐ High Adult Secondary Education / ESL Federal Functioning Levels (FFL)
☐ Beginning ESL Literacy
☐ Low Beginning ESL
☐ High Beginning ESL
☐ Low Intermediate ESL
☐ High Intermediate ESL
☐ Advanced ESL
Standard1-CurriculumandPlanning
1.1Theteacherdemonstratesadeepandextensiveknowledgeofthesubjectmatter.
Distinguished / Accomplished / Emerging / Unsatisfactory
1.2Theteacherdesignsstandards-driveninstructionusingstate-approvedstandards.
Distinguished / Accomplished / Emerging / Unsatisfactory
1.3Theteacherusesabalancedassessmentapproachtoguidestudentlearning.
Distinguished / Accomplished / Emerging / Unsatisfactory
Comments
Standard2-The LearnerandtheLearningEnvironment
2.1Theteacherunderstandsandrespondstotheuniquecharacteristicsoflearners.
Distinguished / Accomplished / Emerging / Unsatisfactory
2.2The teacherestablishesandmaintainsasafeandappropriatelearningenvironment.
Distinguished / Accomplished / Emerging / Unsatisfactory
2.3The teacherestablishesandmaintainsalearner-centeredculture.
Distinguished / Accomplished / Emerging / Unsatisfactory
Comments

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Educator’sName
Date
Standard3-Teaching
3.1The teacherutilizesavarietyofresearch-basedinstructionalstrategies.
Distinguished / Accomplished / Emerging / Unsatisfactory
3.2Theteachermotivatesandengagesstudentsinlearning,problemsolvingand collaboration.
Distinguished / Accomplished / Emerging / Unsatisfactory
3.3Theteacheradjustsinstructionbasedonavarietyofassessmentsandstudentresponses.
Distinguished / Accomplished / Emerging / Unsatisfactory
Comments
Standard4-ProfessionalResponsibilitiesforSelf-Renewal
4.1Theteacherengagesinprofessionaldevelopmentthatguidescontinuousexamination andimprovementofprofessionalpractice.
Distinguished / Accomplished / Emerging / Unsatisfactory
4.2Theteacheractivelyengagesincollaborativelearningopportunitieswithcolleagues.
Distinguished / Accomplished / Emerging / Unsatisfactory
Comments
Standard5-ProfessionalResponsibilitiestoSchoolandCommunity
5.1Theteacherparticipatesincollaborativeeffortstosupportthesuccessofall students.
Distinguished / Accomplished / Emerging / Unsatisfactory
5.2 The teacher works with, families, post-secondary institutions, one-stops, community assistance
programs and other community entities to support student learning and well-being.
Distinguished / Accomplished / Emerging / Unsatisfactory
5.3The teacherpromotespracticesandpoliciesthatimproveschoolenvironmentand studentlearning.
Distinguished / Accomplished / Emerging / Unsatisfactory
Comments