VICTORIA INDEPENDENT SCHOOL DISTRICT
Special Education Counselor Evaluation Form
Name ______Date ______
Social Security No. ______Evaluator ______
Rating Number Rating Notations
4 Exceptional Performance
3 Above Average Performance
2 Good Performance
1 Below Standard Expectation *
No Notation Not in a Position to Evaluate This Skill
* Any comments for indicators can follow the criterion. Any indicator score of Below Standard Expectations (1) must have written justification at the end of the appropriate criterion
Criterion I: Instructional Management (Effective Expectations
instructional management is maintained
through a series of activities)
The primary responsibility will be to provide counseling
services to eligible students.
1. Develop a program of counseling for each eligible 4 3 2 1
student in accordance with his/her IEP and objectives.
2. Develop and maintain a schedule of counseling 4 3 2 1
services in accordance with the ARD committee
recommendations.
3. Maintain records of counseling contract via counseling 4 3 2 1
notes and weekly log.
4. Monitor students’ progress in counseling via teacher 4 3 2 1
observation/reports.
5. Report students’ progress towards counseling IEP 4 3 2 1
goals and objectives through written progress reports
and or attendance at ARD meetings.
Criterion II: School/Organization Climate Expectations
(A productive positive, caring environ-
ment exists)
Parent involvement (provide consultation, training, and/or counseling
to parents to eligible students on an as needed basis)
1. As needed, work with parents in developing and maintaining 4 3 2 1
home behavior management programs.
2. Serve as a liaison between parents and the school or other 4 3 2 1
community agencies.
3. Maintain contact with parents through conferences and 4 3 2 1
attendance at ARD meetings.
4. Coordinate efforts with campus administrators, diagnosticians, 4 3 2 1
LSSP and other school personnel to assist parents.
5. Maintain a record of parent contacts via weekly log and/or 4 3 2 1
case notes
Criterion III: Personnel Management Expectations
(Effective personnel management
practices are implemented)
1. Complies with Medicaid procedures for implementation 4 3 2 1
of School Health and Related Service (SHARS), as required.
Criterion IV: Administration and Fiscal Facilities Expectations
Management (Administrative, fiscal and
facilities are effectively and efficiently
managed)
Gather necessary data about students to determine eligibility
for counseling.
Administer appropriate assessment instruments and 4 3 2 1
develop written summary report.
Observe referred students in the classroom and/or 4 3 2 1
other environments.
Interpret assessment results and report observations 4 3 2 1
to parents, teachers, and ARD committees as necessary.
Use obtained information to develop counseling IEPs 4 3 2 1
for eligible students.
Maintain collected information in a secure and confidential 4 3 2 1
manner.
Criterion IV: Administration and Fiscal Facilities Expectations
Management (Administrative, fiscal and
facilities are effectively and efficiently
managed)
Central Office Responsibilities
1. Attend scheduled meetings. 4 3 2 1
2. Maintain documentation of students served and service 4 3 2 1
provided.
3. Submit reports and communicate information to the 4 3 2 1
special education Coordinator assigned to counselors
as requested.
4. Maintain and report Medicaid paperwork to appropriate 4 3 2 1
person within required time lines (e.g., MACM, SHARS,
and assessment logs).
5. Continue professional growth and responsibilities. 4 3 2 1
Criterion V: Management of Student Services Expectations
(Positive student conduct, self-concept
and collaborative interaction are promoted
through a variety of activities)
1. Keep current of legal requirements, federal state and local 4 3 2 1
policies, and current diagnostic procedures.
2. Attend and/or present programs at professional meetings 4 3 2 1
including district meeting.
3. Assume responsibility for specific tasks assigned by Director 4 3 2 1
of Special Services.
Special Education Counselor’s Comments:
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Evaluator’s Comments:
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______ Signature of Evaluator Signature of Counselor
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Date Date
* The counselor signature indicates neither agreement or disagreement with ratings given.