Clinical/Internship Experiences Dispositions Evaluation (Form M)
To Be Completed by Cooperating Teacher/University Supervisor
Candidate/Intern: Course: Date:
School & Grade Level:Semester:
Please evaluate the candidate on the following characteristics and check whether the candidate is at the Target, Acceptable, or Unacceptable level. Please provide evidence of your evaluations.
Elements / Unacceptable/Needs Improvement1-2 / Acceptable
3-4 / Target
5 / Rating
Attitude
Emotional maturity, Initiative, Responsiveness to professional feedback(receptivity and responsiveness) / vents frustration inappropriately, needs step-by-step instruction, rejects/ignores ideas and suggestions, excessively negative or inappropriately responds to other students, blames others for problems / frustration sometimes interferes with classroom performance, operates independently with direction, occasionally accepts ideas and suggestions, demonstrates minimal responsiveness / handles frustration appropriately, demonstrates independence and initiative, demonstrates receptivity to constructive feedback, listens and responds thoughtfully to feedback / 12345Comments:
Diversity
Values multiple aspects of diversity: respects children and adults of various cultural backgrounds, ethnicities, religions, sexual orientations, social classes, abilities and political beliefs / Demonstrates no respect for cultural, racial, gender and/or religious differences; Demonstrates partiality toward certain groups / Demonstrates respect for cultural, racial, and religious differences by openly discussing, reading, and displaying materials that represent the different cultures, races, genders, and/or religions periodically; Shows no partiality toward certain groups of students / Treats all students, teachers, and parents with respect; Acknowledges and celebrates various cultures, races, and religions by openly discussing, reading stories, and displaying pictures that represent different cultures, races, genders, and/or religions throughout the clinical experience. / 12345Comments:
Enthusiasm
Demonstrates a positive interest and commitment to student learning and teaching / Negative attitude; Displays little interest in students, content, and teaching / Positive most of the time; Displays interest in students, content, and teaching / Always positive; Helps students outside of class time; Searches for innovative methods; Shares ideas; Participates in school activities outside of class time / 12345Comments:
Personal Appearance
Demonstrates attire that is in alignment with the suggested SOE dress code / Dresses unprofessionally; Does not observe dress code; Displays no care in personal hygiene / Generally dresses professionally and observes dress codes; Exhibits care in personal hygiene / Always dresses professionally at school and at extracurricular events; Exhibits care in personal hygiene / 12345Comments:
Professionalism
Demonstrates adherence to the standards of ethical conduct including academic honesty and confidentiality / Gossips; Does not keep information confidential; Dishonest / Observes confidentiality; Demonstrates honesty and integrity / Observes confidentiality; Demonstrates honesty, integrity, and willingness to accept responsibilities beyond the classroom (e.g., athletics, school committees, clubs); Enthusiastic about the teaching profession; Serves as a model of behavior expected of an educator; / 12345Comments:
Punctuality
Meets all time expectations
/ Arrives late to school or class or leaves early / Arrives and leaves at assigned times / Arrives early and stays late as necessary / 12345Comments:
Rapport
Demonstrates an ability to effectively communicate and interact with others
/ Does not interact well with students, parents, faculty, and/or staff / Interacts positively with students, parents, faculty, and staff / Interacts positively with students, faculty, staff, and parents; Initiates contributions to class, school activities or parent conferences which are well received / 12345Comments:
Reliability
Recognizes and fulfills all professional expectations
/ Tasks are not completed within a prescribed time / Completes tasks within prescribed times / Completes all tasks within prescribed times / 12345Comments:
Sensitivity
Demonstrates empathy and understanding for others
/ Displays a lack of concern for students’ abilities and/or needs / Exhibits care and concern for students’ abilities and needs / Exhibits care and concern for students’ abilities and needs; Spends additional time (after school, after class) with students who need help; Seeks information and advice from parents and staff to improve students’ education / 12345Comments:
Teacher Comments:
*Please describe your concern(s) so that it may be addressed. Your suggestions to assist the candidate are welcomed.
Signature of Cooperating Teacher/University SupervisorDate School
Revised 4/29/11