Nauset Public Schools

Nauset Public Schools

NausetPublicSchools

EducatorEvaluationForms

Theformsincludedhereareprovidedastoolstosupporteducatorsastheyimplementtheeducator evaluation framework. Forall of these forms, additional pages maybe attached as needed.

 EvaluationTrackingSheet. Thisformisintendedto beusedtotrackthecompletionofeach step throughouttheeducator’s evaluationprocess. It willbecompleted bytheeducatorinconjunction with his/her Principal or Supervisor.

 Self-AssessmentForm. Thisformisintendedtobeusedin supportofStep 1:Self-Assessment, theeducator’sinitialstep ofthecycle. Theform can beusedbyindividualsor teams;however, each individual will need tosubmit a self-assessment. Evaluators sign the form to indicate receipt. Theformincludes sectionsforthe educatorto completeananalysis ofstudentlearning, growth, andachievementand an assessment ofpractice againstperformancestandards. Submission of this form willbe noted andinitialed on the Educator Tracking Sheet.

 GoalSettingForm. ThisformisintendedtobeusedinsupportofStep1:Self-Assessment and Step 2: Goal Setting and Plan Development. Individuals and teams may use this form to propose goals(aminimumof onestudentlearninggoalandoneprofessionalpracticegoal). Theform shouldinitiallybe submitted withthe Self-AssessmentForm withthebox“ProposedGoals” checked. Ifthegoalsareapprovedaswritten,theevaluatorwill checkthebox “Final Goals” and include a copy ofthe form with the Educator Plan Form. If the goals undergo further refinement, editsmaybemadetotheoriginal,ortheformmayberewritten. Iftheformisredone,thenew formshould havethebox“Final Goals”checkedandshouldthenbeattachedtotheEducator PlanForm. Submission of this form willbe noted andinitialed on theEducator Tracking Sheet.

 EducatorPlanForm. ThisformisintendedtobeusedinsupportofStep2:GoalSettingand Plan Development. Itwill either be completedby the educatorfora Self-Directed GrowthPlan, by theeducator andtheevaluatortogetherfora DirectedGrowthPlanand a Developing Educator Plan,andbytheevaluatorforanImprovementPlan. Completion and/orsubmissionofthisform will be noted and initialedon the Educator TrackingSheet.

 EducatorCollection of Evidence Form. This form isintendedtobeusedtosupportthe educatorincollectingevidenceofhis/herpractice. Itwillbecompletedbytheeducatorand sharedwith the evaluator prior to FormativeAssessment/Evaluation and Summative Evaluation

 Educator ResponseForm. Thisform isintended to beusedin supportofthe educator, should he/shewanttohaveaformalresponsetoanypartoftheevaluationprocess keptonrecord. Itwill be completed by the educator; the evaluator will sign to acknowledge receipt. If the form is submittedin responsetotheFormativeAssessment/EvaluationortotheSummativeEvaluation, receipt of the response will also be noted and initialed on the EducatorTracking Sheet.

Educator—Name/Title:
Evaluator—Name/Title:
School:
Educator Plan: / Self-Directed Growth Plan / Directed Growth Plan
Developing Educator Plan / Improvement Plan
Plan Duration: / 2-Year / One-Year / Less than a year
EvaluationStep / Date(s) / Educator
Initials / Evaluator(s) Initials
Self-Assessment receivedby evaluator
Educator Plan development completed
Formative Assessmentconference, ifany1
Formative Evaluation conference, if any2
Formative Assessment Report completed
Formative Evaluation Report completed 3
Educator response, if any, received by evaluator4
Summative Evaluation conference, if any
Summative Evaluation Report completed
Educator response, if any, received by evaluator

1As per the Massachusetts Model System for EducatorEvaluation ContractLanguage, evaluation conferences are required for ratings of Needs Improvement and Unsatisfactorybut conferences may be requested byeither the educator or evaluator for anyEducatorPlan.The conference mayoccur before or after the Report is completed; the sequence in the above table does not denote required chronological order.

2Formative Evaluation onlyoccurs at the endof the first year of atwo-yearSelf-DirectedGrowthPlan.

3The educator’s formative evaluation rating atthe end of the first year of the two-year cycle shall be the same as the previous summative rating unless evidence demonstrates asignificant change in performance. In such acase, the rating on the formative evaluation may change. Assigning ratings is optional during Formative Assessment.

4An educator mayprovidewritten comments to the evaluator at anytime using the Educator Response Form but 603

CMR 35.06 ensures that educators have anopportunityto respond to theFormative Assessment, FormativeEvaluation, and Summative Evaluation inwriting.

Educator—Name/Title:
Evaluator—Name/Title:
School(s):
Part 1: Analysis of Student Learning, Growth, and Achievement
Briefly summarize areas of strength andhigh-priorityconcerns forstudents underyour responsibility for the upcoming school year. Cite evidence such as results fromavailable assessments. This formshould be individuallysubmitted by educator, but Part1 can also be used by individuals and/or teams who jointly review and analyze student data.
Educator—Name/Title:
Part 1: Analysis of Student Learning, Growth, and Achievement
Briefly summarize areas of strength andhigh-priorityconcerns forstudents underyour responsibility for the upcoming school year. Cite evidence such as results fromavailable assessments. This formshould be individuallysubmitted by educator, but Part1 can also be used by individuals and/or teams who jointly review and analyze student data.
Team, if applicable:
List of Team Members below:
Educator—Name/Title:
Evaluator—Name/Title:
School(s):
Part 2: Assessment of Practice Against Performance Standards
Citing your district’s performance rubric, brieflysummarize areas of strength andhigh-priority areas for growth. Areas may targetspecific Standards, Indicators, or Elements, or spanmultiple Indicators or Elements within or acrossStandards. The formshould be individually submitted by educator, but Part 2 can also beused by teams in preparation for proposing teamgoals.
Educator—Name/Title:
Part 2: Assessment of Practice Against Performance Standards
Citing your district’s performance rubric, brieflysummarize areas of strength andhigh-priority areas for growth. Areas may targetspecific Standards, Indicators, or Elements, or spanmultiple Indicators or Elements within or acrossStandards. The formshould be individually submitted by educator, but Part 2 can also beused by teams in preparation for proposing teamgoals.
Team, if applicable:
List of Team Members below:
Signature of Educator: / Date:
Signature of Evaluator: / Date:

**The evaluator’s signature indicates that he or she has received a copy of the self-assessment form and the goal setting form with proposed goals. It does not denote approval of the goals.

Educator—Name/Title:
School: / Select oneEastham Elementary SchoolEddy Elementary SchoolNauset Regional High SchoolNauset Regional Middle SchoolOrleans Elementary SchoolStony Brook Elementary SchoolWellfleet Elementary School
Checkallthatapply1: / Proposed Goals / Final Goals / Date:

Aminimumofonestudentlearninggoalandoneprofessionalpracticegoalarerequired. Team goalsmustbeconsideredper603CMR35.06(3)(b).Attachpagesasneededforadditional

goalsorrevisionsmadetoproposedgoalsduringthedevelopmentoftheEducatorPlan.

Student Learning SMART Goal Check whethergoal is individual or team; write team name if applicable. / Professional Practice SMART Goal Check whethergoal is individual or team;
write team name if applicable.
Individual
Team: / Individual
Team:

SMART: S=Specific and Strategic; M=Measurable; A=Action Oriented; R=Rigorous, Realistic, and Results-Focused; T=Timed andTracked

1If proposed goals change during Plan Development, edits maybe recordeddirectlyon original sheet or revised goal maybe recorded on anewsheet. If proposed goals are approved aswritten, a separatesheet is not required.

Educator—Name/Title:
Evaluator—Name/Title:
School:
Educator Plan: / Self-Directed Growth Plan / Directed Growth Plan
Developing Educator Plan / Improvement Plan
Plan Duration: / 2-Year / One-Year / Less than a year
Start Date: / End Date:

GoalSettingFormwithfinalgoalsisattachedtotheEducatorPlan.

Someactivitiesmayapplytothepursuitofmultiplegoalsortypesofgoals(studentlearningor professionalpractice). Attachadditionalpagesasnecessary.

StudentLearningGoal(s):PlannedActivitiesDescribeactionsthe educatorwilltaketoattainthestudentlearninggoal(s).Activitiesmayapplytoindividualand/orteam.Attachadditionalpagesasneeded.
Action / Supports/Resources from School/District1 / Timeline or Frequency / Evidence
Process & Outcomes

*Additionaldetailmaybeattachedifneeded

Educator—Name/Title:
StudentLearningGoal(s):PlannedActivitiesDescribeactionsthe educatorwilltaketoattainthestudentlearninggoal(s).Activitiesmayapplytoindividualand/orteam.Attachadditionalpagesasneeded.
Action / Supports/Resources from School/District1 / Timeline or Frequency / Evidence
Process & Outcomes
Educator—Name/Title:
ProfessionalPracticeGoal(s):PlannedActivitiesDescribe actionstheeducatorwilltaketoattaintheprofessionalpracticegoal(s).Activitiesmayapplytoindividualand/orteam.Attachadditionalpagesasneeded.
Action / Supports/Resources from School/District1 / Timeline or Frequency / Evidence
Process & Outcomes
Educator—Name/Title:
ProfessionalPracticeGoal(s):PlannedActivitiesDescribe actionstheeducatorwilltaketoattaintheprofessionalpracticegoal(s).Activitiesmayapplytoindividualand/orteam.Attachadditionalpagesasneeded.
Action / Supports/Resources from School/District1 / Timeline or Frequency / Evidence
Process & Outcomes

ThisEducatorPlanis“designedtoprovideeducatorswithfeedbackforimprovement, professionalgrowth,andleadership,”is“alignedtostatewideStandardsandIndicators in603CMR35.00andlocalPerformanceStandards,”and“isconsistentwithdistrictand schoolgoals.”(see603CMR35.06(3)(d)and603CMR35.06(3)(f).)

Signature of Educator: / Date:
Signature of Evaluator: / Date:

* As the evaluator retains finalauthority overgoals to be included in an educator’s plan (see 603 CMR 35.06(3)(c)), the signature ofthe educator indicates that he or she has received the Goal Setting Form with the “Final Goal” box checked, indicating theevaluator’s approvalof the goals. The educator’s signature doesnot necessarily denote agreementwith the goals. Regardless of agreementwith the final goals, signature indicates recognition that “It is the educator’s responsibilityto attain the goals in the planand to participate inanytrainings and professional development provided through thestate, district, or other providers inaccordancewith theEducator Plan.” (see 603 CMR 35.06(4))

1Must identifymeans for educator toreceive feedback for improvement per 603 CMR 35.06(3)(d)

Educator—Name/Title:
Evaluator—Name/Title:
School:

Evidence pertains to (check all that apply)1:

Fulfillment of professional responsibilities and growth
Progress toward attaining student learning goal(s)
Evidence of outreach to and ongoing engagement with families
Progress toward attaining professional practice goal(s)
Other:
Summary of Evidence
Summarize the evidence compiled to be presented to evaluator with a brief analysis.
Attach additional pages as needed.
Signature of Educator: / Date:

1Per 603 CMR35.07(1)(c)1, “Evidence compiled and presented bythe educator includ[es]: 1. Evidence of fulfillment of professional responsibilitiesand growth, such as: self-assessments; peer collaboration; professional development linked to goalsand or educator plans; contributions to the school community and professional culture; 2. Evidence of active outreachto and ongoing engagementwith families.” However, educator collectionof evidence isnotlimitedto these areas.

October 2012

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