Teacher:	School:

Grade Level/Subject:	Date:

U=Unsatisfactory	NI=Needs Improvement	P=Proficient	E=Excellent

Domain 1 –Planning and Preparation (circle domain rating)	U	NI	P	E
1a. Knowledge of Content and Pedagogy
1b. Knowledge of Colleagues and Adult Learners
1c. Setting Instructional Goals
1d. Designing Coherent Instruction with Appropriate Resources
1e. Designing an Evaluative Plan
Domain 2- The Classroom Environment (circle domain rating)	U	NI	P	E
2a. Creating an Environment of Respect and Rapport
2b. Establishing a Culture for Ongoing Instructional Improvement
2c. Managing Classroom Procedures and Physical Space
2d. Managing Behaviors and Expectations
Domain 3 –Instruction (circle domain rating)	U	NI	P	E
3a. Communicating with Staff
3b. Using Questioning and Discussion Techniques
3c. Engaging in Learning
3d. Using Assessment in Instruction
3e. Demonstrating Flexibility and Responsiveness
Domain 4 –Professional Responsibilities: (circle domain rating)	U	NI	P	E
4a. Reflecting on Practice
4b. Maintaining Accurate Records
4c. Communicating with Staff
4d. Growing Individually and Collectively as a Professional
4e. Showing Professionalism