HARRISON SCHOOL DISTRICT TWO, SERVICE DELIVERY FEEDBACK FORM (October 2013)

HARRISON SCHOOL DISTRICT TWO, SERVICE DELIVERY FEEDBACK FORM (October 2013)

SCHOOL PSYCHOLOGIST (continued)

Provider: / Observer: / Date:
Assignment: / Time in: / Time out:
Description of session, program lesson, meeting or training:
*Evaluator comments are required for ratings of Unsatisfactory or Progressing.
U=Unsatisfactory PR= Progressing P=Proficient E=Exemplary N/O=Not Observed
Standard 1: Planning and Preparation
Establishes session goals or meeting outcomes
U PR P E N/O / COMMENTS:
Plans interventions, accommodations and modifications to maximize likelihood of student success U PR P E N/O
Applies knowledge of state/federal regulations and of resources both within and beyond the school and district
U PR P E N/O
Standard 2: Data Informed Decision Making
Demonstrates knowledge and skill in using psychological instruments to evaluate students
U PR P E N/O / COMMENTS:
Analyzes and uses results from multiple sources or assessments in decision making
U PR P E N/O
Provides appropriate feedback
U PR P E N/O
Utilizes technology to gather data and enhance the learning environment
U PR P E N/O
Standard 3: Delivery of Service
Assumes director designee responsibilities
U PR P E N/O / COMMENTS:
Ensures sessions or meetings are focused and productive while promoting active participation
U PR P E N/O
Uses a variety of materials, methods and strategies to remove barriers to learning
U PR P E N/O
Demonstrates flexibility and responsiveness
U PR P E N/O

HARRISON SCHOOL DISTRICT TWO, SERVICE DELIVERY FEEDBACK FORM (October 2013)

SCHOOL PSYCHOLOGIST (continued)

Standard 4: Interventions
Recommends, implements or monitors academic interventions and appropriate interventions for students with social, emotional and behavioral needs
U PR P E N/O / COMMENTS:
Uses appropriate tools for identifying early warning signs of children at risk and implements pre-referral interventions for learning and social/emotional behavioral problems
U PR P E N/O
Participates as a member of an intervention or solution team
U PR P E N/O
Standard 5: Contributions to the Learning Environment
Models positive and respectful rapport
U PR P E N/O / COMMENTS:
Respects diversity among others
U PR P E N/O
Provider: / Observer: / Date:
Additional Evaluator Comments:
Provider Comments:

Provider Signature: ______Date: ______

Evaluator Signature: ______Date: ______