A
ustin Teacher Program Austin College
ATP F
ield Supervisor - Lesson Evaluation Form
This instrument helps to provide feedback to Interns/Clinicals as they work with individuals, a small group or the entire class. The
Intern/Clinical may also choose to use it as a self-evaluation tool.
To the Field Supervisor: Please highlight at least one area of reinforcement and refinement.
Intern/Clinical:
TEA #:
Date:
Grade Level:
School:
District:
Subject:
Begin Time:
Mentor:
End Time:
ATP Field Supervisor:
Scale:
Proficient
Developing
Improvement
Needed
N/A
DOMAIN 1: PLANNING
Evidence is apparent in the instructional lesson plan, classroom observations.
Standards & Alignment: The Intern/Clinical designs, organizes and implements a clear, well-organized lesson that reflects best practice, aligns
with standards and are appropriate for diverse learners
Data & Assessment: The Intern/Clinical uses formal and informal methods to measure student
Knowledge of Students: Through knowledge of students and proven practices, the Intern/Clinical ensures high levels of learning, social-
emotional development and achievement for all students.
Activities: The Intern/Clinical plans engaging, flexible lessons that encourage higher-order thinking, persistence and achievement.
Evidence:
1
Revised 5/15/2018
Proficient
Developing
Improvement
Needed
N/A
DOMAIN 2: INSTRUCTION
Evidence is apparent in instruction and classroom.
Achieving Expectations: The Intern/Clinical supports all learners in the pursuit of high levels of academic and social-emotional success.
Content Knowledge & Expertise: The Intern/Clinical uses content and pedagogical expertise to design and execute lessons aligned with state
standards, related content and student needs.
Communication: The Intern/Clinical clearly and accurately communicates to support persistence, deeper learning and effective effort.
Differentiation: The Intern/Clinical differentiates instruction, aligning methods and techniques to diverse student needs.
and
Monitor & Adjust: The Intern/Clinical formally and informally collects, analyzes and uses student progress data and makes needed lesson
adjustments.
Evidence:
2
Revised 5/15/2018
Proficient
Developing
Improvement
Needed
N/A
DOMAIN 3: Learning Environment
Evidence is apparent in the classroom.
Classroom Environment, Routines & Procedures: The Intern/Clinical organizes a safe, accessible and efficient classroom.
Managing Student Behavior: The Intern/Clinical establishes, communicates and maintains clear expectations for student behavior.
Classroom Culture: the Intern/Clinical leads a mutually respectful and collaborative class of actively engaged learners.
Evidence:
Proficient
Developing
Improvement
Needed
N/A
DOMAIN 4: Professional Roles and Responsibilities
Evidence is apparent in the classroom.
Program Responsibilities - The Intern/Clinical Teacher:
Evidence:
3
Revised 5/15/2018
Summary:
Re
inforcement:
Refinement:
Pre-conference was conducted
Post-conference was conducted
Date:
Date:
Via:
(Email, Phone, In-person, Online)
Via:
(Synchronous: e.g. Phone, In-Person)
Teacher Candidate:
Field Supervisor:
Signature:
Signature:
Date:
Date:
4
Revised 5/15/2018
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