3/2019
AACS Supervised Teacher Verification Form
Teacher Name ______________________________________________________________________________
Email _________________________________________________ Phone ______________________________
Grade(s) teaching (elementary) ________________________________________________________________
Grade(s) and/or subject(s) teaching (secondary) ___________________________________________________
Supervised Teaching
Time frame of supervised teaching:
Beginning Date ________________________
Ending Date ___________________________
Teacher was supervised by ____________________________________ Position ________________________
Formal Observation (three requiredblank copy of observation form should be enclosed)
Dates:
1. ________________ Observed by _______________________________________________________
2. ________________ Observed by _______________________________________________________
3. ________________ Observed by _______________________________________________________
4. ________________ Observed by _______________________________________________________
Follow-up Conferences (three requiredblank copy of conference form should be enclosed)
Dates:
1. ________________ Conference with ____________________________________________________
2. ________________ Conference with ____________________________________________________
3. ________________ Conference with ____________________________________________________
4. ________________ Conference with ____________________________________________________
Copies of the above observations and follow-up conferences are on file in this teacher’s personnel file in the
school office.
________________________________________________________________________ _________________
Administrator’s Signature Date
School ____________________________________________________________________________________
Address _________________________________________ Email ____________________________________
City ________________________________ State _____ Zip __________Phone ________________________
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signature
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