Evaluation Form:
Supporting Services Professional Growth System
Office of Human Resources and Development (OHRD)
Department of Professional Growth Systems
MONTGOMERY COUNTY PUBLIC SCHOOLS
Rockville, Maryland
Negotiated Agreement between SEIU Local 500, CTW, and the Board of Education of Montgomery County
Name ___________________________________________________ Employee ID # Date
□  *Permanent Status Evaluation □  Scheduled Evaluation □  **Off-cycle Evaluation □  PAR Follow-UP □  ***Interim Evaluation
Department/School
Position
Notes: *** If this is a Permanent Status Evaluation, probationary employees should be able to demonstrate their potential to meet the
general and technical Knowledge of Job core competency performance criteria.
*** An Off-cycle Evaluation can be used:
as a tool to work with underperforming employees to let them know the status of their current performance
as a way to call attention to exceptionally good work
following the end of the 90-day special evaluation within the Performance Improvement Process
*** An Interim Evaluation is prepared if there is a change of supervisor or if employees transfer prior to the time for their
regularly scheduled performance evaluation. (See Article 30, paragraph B2 of the Negotiated Agreement between SEIU
Local 500, CTW, and the Board of Education of Montgomery County.)
Roles and Responsibilities
The evaluator is the direct line supervisor. The reviewer is a higher level supervisor, if one exists. Montgomery County Education
Association (MCEA) employees do not write evaluations and are not evaluators or reviewers, but may provide indirect feedback.
(See Supporting Services Professional Growth System (SSPGS)—then link to: http://www.montgomeryschoolsmd.org/departments/
professionalgrowth/supporting/default.aspx Handbook for clarification.)
Providing Examples and Evidence
In the “Examples/Evidence” section, provide specific examples/evidence of how employees have demonstrated or not demonstrated
meeting competency. Narratives written in the Claim, Examples/Evidence, Impact, Judgment (CEIJ) format are preferred.
Completing the Form
Evaluator completes all parts of the form. Reviewer reviews and signs the form. No section of the form should be left blank.
Evaluator discusses the evaluation with the employee.
Evaluator and employee sign the evaluation.
One copy is kept in the employee’s local file, one is given to the employee, and one is sent to the OHRD Department of
Professional Growth Systems.
Due Dates
Permanent Status Evaluation: Due no later than six months after the date of hire.
Scheduled Evaluation:
Meets Competency: Submit by the last instructional day for students.
Does Not Meet Competency: Submit by first Friday in March.
Peer Assistance and Review (PAR) Follow-Up: Due one year after completing PAR.
MCPS Form 430-90
January 2018
Page 1 of 6
Name ______________________________________________________ Employee ID # Date
MCPS Form 430-90, January 2018 Page 2 of 6
PART I—CORE COMPETENCIES
The core competencies listed below are defined by performance criteria. These performance criteria offer suggestions for how the core
competencies may be observed. (See SSPGS Handbook.)
Rating: There are two possible ratings—Meets Competency and Does Not Meet Competency. Using the examples/evidence, determine
the overall assessment of the employee’s performance in a particular competency.
Meets Competency (MC): Reflects performance over a sustained period of time that clearly and consistently meets competency
performance criteria as cited in the SSPGS Handbook.
Does Not Meet Competency (NMC): Reflects performance that regularly fails to meet competency performance criteria.
Core Competencies/Performance Criteria Examples/Evidence Rating
COMMITMENT TO STUDENTS
Understands how the job contributes to
Success for Every Student
Cares genuinely about the overall learning
environment to ensure student success
Acts with the student in mind
Is dedicated to meeting expectations
of principals, supervisors, staff, parents/
guardians, and students
Is dedicated to supporting high-quality
education for students
Is dedicated to the successful achievement/
performance of all groups by supporting the
elimination of racial and ethnic inequalities
□  MC
□  NMC
KNOWLEDGE OF JOB
General Competencies
- Understands assigned job duties
- Is knowledgeable about current and new
practices and methods
- Uses appropriate materials, equipment, and
resources
- Implements and completes work
assignments
- Learns new skills and procedures
- Knows appropriate policies, procedures, and
regulations
Technical Competencies
Applies the knowledge and skills needed to
do the job, including technical competencies
required by employee’s specific position
classification (See job description and
Reference Checklist.)
□  MC
□  NMC
Core Competencies/Performance Criteria Examples/Evidence Rating
PROFESSIONALISM
Patient to hear the entire story
Calm under pressure
Timely with information
Positive, dependable, reliable, and trustworthy
Responds to all people equitably
Proactive when handling all situations
Possesses the ability to handle all matters in a
professional and confidential manner
□  MC
□  NMC
INTERPERSONAL
Polite and approachable
Able to be a team member/team player
Cares about people
Available and ready to help
Treats people with respect
Acts as a mentor and a student advocate
Attempts to understand other perspectives
Relates well to others
□  MC
□  NMC
Name ______________________________________________________ Employee ID #
Date
MCPS Form 430-90, January 2018 Page 3 of 6
Core Competencies/Performance Criteria Examples/Evidence Rating
COMMUNICATION
Understands how to be an active listener
Effective in oral and written skills
Able to communicate well to manage conflict
and deal effectively with problem situations
Tactful when handling situations and difficulties
with the least possible disruption
□  MC
□  NMC
ORGANIZATION
Knows how to get things done in the
classroom, school, office, or other work
locations
Assists as needed to organize meetings and
tasks
Anticipates needs of principals, supervisors,
staff, parents/guardians, and students
Gets things done in a timely manner
Manages a broad range of activities
□  MC
□  NMC
Name ______________________________________________________ Employee ID #
Date
MCPS Form 430-90, January 2018 Page 4 of 6
Core Competencies/Performance Criteria Examples/Evidence Rating
PROBLEM SOLVING
Changes routines to fit the needs of the
situation
Accesses and uses resources effectively and
efficiently
Identifies process improvements
Explores beyond the obvious when solving
problems
Asks appropriate questions to clarify a situation
Logical when discussing the pros and cons of
situations
Quickly recognizes issues and their implications
□  MC
□  NMC
PART II—ADDITIONAL COMMENTS
(For example, you might address the past year’s record of accomplishments, letters of recommendation, and training courses taken.)
Name ______________________________________________________ Employee ID #
Date
MCPS Form 430-90, January 2018 Page 5 of 6
MCPS Form 430-90, January 2018 Page 6 of 6
PART III—SUGGESTIONS FOR CONTINUED PROFESSIONAL DEVELOPMENT
PART IV—FINAL RATING
Please indicate the final rating by checking the appropriate box below. Evidence and comments to support this rating should be
included in Parts I, II, and III.
□  Meets all core competencies □  Does not meet one or more of the core competencies
PART V—SIGNATURES
/ /
Signature, Evaluator Date Printed Name and Job Title, Evaluator
/ /
Signature, Reviewer Date Printed Name and Job Title, Reviewer
I have participated in this evaluation / /
Signature, Employee Date
(BY SIGNING THIS EVALUATION THE EMPLOYEE DOES NOT NECESSARILY HAVE TO AGREE WITH THE CONTENTS AND MAY ATTACH
COMMENTS TO THIS FORM.)
Name ______________________________________________________ Employee ID #
Date