Assignment Template for

Course 2: Working with Teachers to

Improve Instruction

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 Metro RESA Teacher Leader Endorsement Program

Article Analysis Exercise

Guiding Questions
Name: Click or tap here to enter text.
Date: Click or tap here to enter text.

Title of Article: The Developmental Stages of Teachers

1. Identify and briefly describe Fuller’s three developmental stages of teachers.

Click or tap here to enter text.

2. Explain the implications of this research on your work as a teacher leader.

Click or tap here to enter text.

Not evident Emerging Points

0-2 3-4 Earned
Identification/ The summary includes only one The summary includes all of the
description of or two of the required pieces of required information
stages the information.
Implications for The implications for teaching and The implications for teaching and
work as a teacher learning are not provided, are learning are provided, including a
leader unclear, or are incomplete. discussion of training/mentoring
integrated with an understanding of
the stages of teacher development.
Points possible = 8

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 Metro RESA Teacher Leader Endorsement Program

Action Research Assignment

(Course 2, TLE)
Name: Danielle Holmes and Paul McNeil
Date: December 17th, 2020

Proposal
(Must be approved by course instructor not later than Session 3 of Course 2)

1. Research Question:
-How does teacher motivation impact job performance, student achievement, and school
culture?

2. Please provide citations for current research on the proposed research question.
(At least three sources must be provided.)
-1.) Teacher Motivation and Student Learning:
https://www.researchgate.net/publication/319152013_Teacher_motivation_and_student_l
earning - 2.) "The Power of Positive" by John Gordon:
http://www.jongordon.com/positivetip/documents/POPLteaser1.pdf -3.) Impact of
Teacher Morale and School Culture on Student Achievement:
https://digitalcommons.gardner-webb.edu/cgi/viewcontent.cgi?
article=1348&context=education_etd

3. Hypothesis (based upon a review of the literature):

-There is a significant and relative realtionship between teacher's motivation, job
performance, school culture, and student's academic outcomes.

4. Proposed Methodology
-To utilize progression focused coaching by providing specific praise, postive
constructive criticisim, and data driven conversations that encourage teachers to use
intentional and intensive practices that will utlimately increase teacher motivation, impact
performance of targeted students, and the efficacy of school culture.

5. Explain how technology as represented by at least one ISTE Standard will be

employed. (If no technology will be employed, provide a rationale for the lack of
a technology component.)
-Technology will be employed in this research by representing ISTE Standards such as
the Learner, Collaborator, and Analyst. The Learner will leverage technology to mointor
student performace. As a Collaborator, technology will be used to collaborate with
teachers and students to improve pratices and share resources. The Analyst will use and
understand data to drive their instruction and support students in achieving their learning
goals.

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 Metro RESA Teacher Leader Endorsement Program

6. Are there any ethical, legal, or moral issues associated with your proposed action
research project? If so, how will you address them?
-There are no ethical, legal, or moral issuses associated with the proposed action research
project.

___________________________________________________ ____________________

Course Instructor Date

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 Metro RESA Teacher Leader Endorsement Program

Consent Form for Action Research

If there are any ethical issues associated with the proposed action research project, this
form should be submitted with the Action Research Proposal.

Name(s) of Researcher(s):
Click or tap here to enter text.

1. Identify the question to be addressed in the research?

Click or tap here to enter text.

2. Explain the methodology that will be used.

Click or tap here to enter text.

3. Explain how the identity of the subjects will be protected.

Click or tap here to enter text.

4. Explain how the results of the research findings will be used.

Click or tap here to enter text.

I understand the proposed research project and agree to participate in it.

Name of subject: Click or tap here to enter text.

Signature of Subject: Date:

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 Metro RESA Teacher Leader Endorsement Program

Action Research Report

(Attach approved Proposal for Action Research Assignment to this form.)

1. Summarize the findings of your research.

Click or tap here to enter text.

2. If your findings are inconsistent with the literature review, please explain why
you think there is a discrepancy.
Click or tap here to enter text.

3. What conclusions can you draw from your findings?

Click or tap here to enter text.

4. What are the implications of these findings for teaching and learning?
Click or tap here to enter text.

5. As a teacher leader, how would you use the findings from this research?
Click or tap here to enter text.

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 Rubric for Proposal for Action Research Assignment
Not evident Standard Met Points
0 1 Earned
Research Question The research question is problematic. The research question is clear, doable, and significant to
teaching and learning.
Literature Review Fewer than three sources are cited. At least three sources are cited. Sources reflect research
within the last 10 years.
Hypothesis The hypothesis is not supported by current There is clear evidence that the candidate has conducted a
research. Fewer than three sources are cited. literature review, at least three sources are cited, and the
hypothesis is supported by current research.
Methodology The methodology is unclear, does not support The methodology supports the research question, is doable,
the research question, or violates ethical, legal and does not violate any ethical, legal, or moral issues. A
or moral issues. A technology component is technology component is present or a rationale for no
included or a rationale for no technology technology is present.
component is present.

Points possible = 4 Points Required = 4

Rubric for Action Research Report

Not evident Emerging Standard Met Points
0-3 4-7 8-10 Earned
Research The summary includes only one The summary includes two of the The summary includes a clear, concise
Summary of the required pieces of the three required pieces of statement of the question, hypothesis, and
information. information methodology.
Conclusions The conclusions drawn are not The conclusions drawn are The conclusions drawn are clearly
supported by the findings. somewhat supported by the supported by the findings and are
findings. consistent with the current research. If
findings are inconsistent with current
research, the candidate provides a valid
reason for the inconsistency.
Implications for The implications for teaching and The implications for teaching and The implications for teaching and
teaching/learning learning are not provided, are learning are provided but need to learning are clear, strong, and supported
unclear, or are not supported by be strengthened. by the findings as well as by current
the findings. research.
Points possible = 30 Points required = 24

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 Clinical Supervision Cycle Portfolio

This is the culminating assignment for Working with Teachers to Improve Instruction. It
provides the Teacher Leader candidate with the opportunity to demonstrate the
knowledge and skills addressed in Courses 1 and 2. More specifically, this assignment
requires candidates to demonstrate their cognitive knowledge, technical skills, and
interpersonal skills. To complete this assignment, the candidate will identify a teacher
who is willing to work with him or her to develop the skills needed for effective
supervision. The documentation submitted by the candidate must reflect a total sequence
for the same lesson. In other words, the pre-observation conference, observation, and
post-observation conference must be addressing the same lesson. The specific
instructions for completing this assignment are provided below:

Instructions for Completing Supervision Cycle Portfolio Assignment

The candidate should:

1. Identify a teacher who agrees to assist him or her with developing his or her
clinical supervision skills. The best candidates for this activity are
Glickman’s “unfocused workers.”
2. Provide the teacher with the letter outlining the specific activities included in
this project. (Letter is in packet.) Obtain the teacher’s signatures on the letter.
Send a copy of the signed letter to the principal.
3. Obtain the teacher’s signature on the Release Form for video recording
4. Obtain the principal’s signature on the Release Form.
5. Complete and compile the following information. The portfolio should be
organized in the following order:
1. Cover page “Clinical Supervision Cycle Teacher Supervisory Plan”
2. Signed Letter to Teacher
3. Release Form with three signatures: Teacher Being Supervised, Principal,
and Candidate
4. Section I: Establishing the Context
5. Section II: Pre-observation Conference Summary (Please provide a video
recording of the pre-observation conference. The recording should be
labeled with the name of the Teacher and Candidate.)
6. Section III: Observation notes. (Please provide a video recording of the
lesson observed. The recording should be labeled with the name of the
Teacher and Candidate.)
7. Section IV: Post-Observation Conference Summary. (Please provide a
recording of the post-observation conference. The recording should be
labeled with the name of the teacher and candidate. The candidate should
also solicit written feedback from the teacher being supervised using the
survey provided. )
8. Section V: Reflections

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 Metro RESA Teacher Leader Endorsement Program

SECTION I: ESTABLISHING THE CONTEXT

The candidate should provide information about the supervisory context. Such
information should include:

1. A description of the school environment. The candidate will write a

description of his or her school. This description should be based upon a
review of multiple data sources including the School Improvement Plan,
student achievement data for a three-year period, attendance data, drop-out
data, demographic data, mobility data, student retention data, etc. Based
upon the review, the candidate should identify the school’s strengths and
weaknesses. This part of the assignment may be completed as a group
assignment if multiple candidates are employed at the same school.

2. Profile of the teacher who is being supervised. The candidate should

include information such as number of years in teaching (beginning
teacher, etc.); number of years at this school setting; highest degree held;
staff development activities over the past two years; views about
supervision in general.

3. Profile of the class. The candidate should include information such as

number of students, grade level, number of students with special needs,
number of girls v. boys, ethnicity of students, socio-economic status of
students, subject, achievement level, etc.)

SECTION II: PRE-OBSERVATION CONFERENCE

Pre-observation Conference: The candidate should conduct a pre-observation

conference with the teacher. The conference should be recorded on video. After
the conference, the candidates should complete the Pre-Observation Conference
Summary forms. The candidate should also elicit feedback from the teacher using
the Teacher Feedback Form.

This conference should be held in the teacher’s classroom, if possible. If the

conference is conducted virtually it should be done in such a way that the subject
teacher is in a comfortable environment.

SECTION III: THE CLASSROOM OBSERVATION

Observation: After conducting the pre-observation conference, the Teacher

candidate should observe the teacher and collect data. For the purposes of this
assignment, the classroom observation should be at least twenty (20) and not
longer than forty (40) minutes long. With the written permission of the teacher
and principal, this observation should be recorded on video. At the end of the

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 Metro RESA Teacher Leader Endorsement Program

endorsement course, the candidate will return all recordings to the teacher or
destroy them. After reviewing the video recording, the candidate will complete
the Classroom Observation Summary form and attach observation data.

SECTION IV: THE POST-OBSERVATION CONFERENCE

Post-Observation Conference: This activity should be recorded on video.

The candidate will conduct a post-observation conference with the teacher
observed. This conference should be held in the teacher’s classroom, if possible.
The candidate should elicit feedback from the teacher by asking him or her to
complete the Teacher Feedback form. Following the conference, the Teacher
candidate will complete the Post-Observation Conference Summary.

If the conference is conducted virtually it should be done in such a way that the
subject teacher is in a comfortable environment.

SECTION V: REFLECTIONS

The candidate will write a reflective paper of not more than three typed pages
sharing the insights gained about the process of working with teachers in his or
her role as a teacher leader. This paper should also provide the candidate’s
reflections on the entire course, Working with Teacher Leaders to Improve
Instruction.

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 Metro RESA Teacher Leader Endorsement Program

Clinical Supervision Cycle Portfolio

Name of Teacher Leader Candidate

Name of Teacher Being Supervised

(Documentation is required for only one of the two teachers selected.)
Name of School

Course 2: Working with Teacher Leaders to Improve Instruction

Teacher Leader Endorsement Program

Metro RESA

Date

Please note: Prior to video recording of teachers, Teacher Leader Candidates must
obtain written permission from the teachers being observed and principal. A
Release Form is included in this packet.)

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 Metro RESA Teacher Leader Endorsement Program

Letter to Teacher

Dear Teacher,
Thank you for agreeing to work with the candidate who is completing Metro
RESA’s Teacher Leader Endorsement program. One of the objectives of the program is
to provide candidates with opportunities to develop and practice instructional supervision
skills. To that end, the Teacher Leader candidates will be required to observe teachers
and provide them feedback that will enable them to improve instruction.
The purpose of this letter is to share with you our expectations regarding your
participation in this activity. Below is a summary of those expectations:
1. You will be observed at least once.
2. Prior to the observation, the candidate will conduct a pre-observation
conference with you. This conference will be recorded on video and included
in the candidate’s portfolio.
3. Candidates will collect data during the observation. The candidate will also
record the observation on video and include it in his or her portfolio.
4. Following the observation, the candidate will conduct a post-observation
conference with you. This conference will be recorded on video and included
in the candidate’s portfolio.
5. Following each conference, you will be asked to provide written feedback to
the candidate on his or her performance using a form provided by the
candidate.
Please note that all recordings will be returned to you at the end of this course or
destroyed. Please note also that the primary focus of this experience is on developing the
skills of the Teacher Leader candidate – not on assessing your performance.

Thank you for helping us develop effective teacher leaders.

_______________________________________________ ____________________
Signature of Teacher Being Supervised Date

______________________________________________ ____________________
Signature of Teacher Leader Candidate Date

Copy: Principal of Teacher Being Supervised

Site Supervisor

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 Metro RESA Teacher Leader Endorsement Program

Release Form

I agree to have my pre and post-conferences video recorded for purposes of training
practicing or prospective teacher leaders. I understand that this recording may be
reviewed by the class instructor and will be returned to me at the end of the course,
Working with Teachers to Improve Instruction, or destroyed.

____________________________________________ __________________________
Teacher being supervised Date

___________________________________________ ________________________
Principal Date

__________________________________________ _______________________
Teacher Leader Candidate Date

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 Metro RESA Teacher Leader Endorsement Program

Section I: Establishing the Context

A. Description of school environment

Mary McLeod Bethune Elementary services an average of 700 students with 94%
african american that are from the community of College Park, Georgia. Mary M.
Bethune's vision is to provide our population of students with a 21st century
learning institution that prepares students for the future success by providing
high-quality, rigorious , and personalized instruction in a safe and nurturing
enviornment. Our school environment is catered to a hybrid learning model that
supports students face-to- face and remotely from home. We currently hold a 4
star overall school climate rating on our 2019 CCRPI scores and adopted practices
and will close performance gaps in our

B. Description of the teacher who is being supervised

Marcia Howard is a 30 year veteran teacher coming from a school district outside
of Fulton county. from

C. Description of class setting

Mrs. Howard's 5th grade class is

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 Metro RESA Teacher Leader Endorsement Program

Section II: Pre-observation Conference Summary

(Video recording must be provided.)
Name of teacher: Click or tap here to enter text.
Date of conference: Click or tap here to enter text.________

1. In which of Glickman’s categories would you place this teacher? Why?

Click or tap here to enter text.

2. What was your conference objective? Was it achieved? If not, explain the
challenges you encountered?
Click or tap here to enter text.

3. What supervisory style did you use with this teacher? Was it appropriate?
Explain.
Click or tap here to enter text.

4. What specific information about the upcoming lesson did you obtain during this
conference?
Click or tap here to enter text.

5. How do you think the teacher was helped by this pre-observation conference?
Provide specific evidence to support your response.
Click or tap here to enter text.

6. What personal/professional strengths and weaknesses were you able to identify as

a result of this activity? (Be sure your response includes the written feedback
provided by the teacher to you.)
Click or tap here to enter text.

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 Metro RESA Teacher Leader Endorsement Program

Section III: Classroom Observation Summary

(Video recording must be provided. Also, please attach observation data.)

Teacher Observed: Click or tap here to enter text.

Observer: Click or tap here to enter text.
Date of Observation: Click or tap here to enter text.
Duration of Observation: Click or tap here to enter text.

1. Was this observation focused or unfocused?

Click or tap here to enter text.

2. Summarize the lesson (provide an objective account of the lesson outline.)

Click or tap here to enter text.

3. Based upon the data collected, summarize the strengths and weaknesses of the
lesson.
Click or tap here to enter text.

4. Was technology employed during the lesson? If so, what was it and was it
appropriate? If no technology was employed, could technology have strengthened
the lesson and/or improved student learning or engagement? If so, how?
Click or tap here to enter text.

5. Based upon the analysis of the data, identify your objective for the post-
observation conference.
Click or tap here to enter text.

6. What personal/professional strengths and weaknesses were you able to identify as

a result of this activity?
Click or tap here to enter text.

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 Metro RESA Teacher Leader Endorsement Program

Section IV: Post—Observation Conference Summary

(Please provide video recording of conference.)

1. Into which of Glickman’s categories would you place this teacher? Why?
Click or tap here to enter text.

2. What supervisory style did you use in your post-observation conference? Was
it appropriate? Explain.
Click or tap here to enter text.

3. What was the objective of the post-observation conference? Did you achieve
the objective? How do you know?
Click or tap here to enter text.

4. If you didn’t achieve your objective, what barriers did you encounter? How
might you have avoided or overcome those barriers?
Click or tap here to enter text.

5. What would your next steps be in working with this teacher?

Click or tap here to enter text.

6. What personal/professional strengths and weaknesses were you able to

identify as a result of this activity? (Be sure your response includes the
written feedback provided by the teacher to you.)
Click or tap here to enter text.

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 Metro RESA Teacher Leader Endorsement Program

Teacher Feedback Form (Pre-Observation Conference)

The candidate should elicit feedback from the teacher after each conference. The
teacher’s feedback should be summarized and included in the Teacher Leader candidate’s
assessment of his or her performance. This form is for the use of the candidate and it
does not have to be included in the portfolio.

Name of Teacher Leader Candidate __________________________________________

Teacher Observed: ______________________________Date of Observation _________

Please provide your honest assessment of my performance by responding to the

statements below.

Strongly Disagree Not Agree Strongly

Disagree sure Agree
The tone of the conference was positive and
professional
The candidate’s questions helped me analyze
and improve my upcoming lesson.
I feel more comfortable with the upcoming
observation as a result of this conference.
I understand the focus of the upcoming
observation..
I understand what to expect after the
observation.
My overall rating of the candidate’s Poor Fair Not Good Excellent
sure
performance is

Answer the following questions:

1. What did you like most about this conference experience?

2. What did you like least about this conference experience?

3. What suggestions can you offer the candidate to improve his or her performance
as a teacher leader

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 Teacher Feedback Form (Post-Observation Conference)

The candidate should elicit feedback from the teacher after each conference. The
teacher’s feedback should be summarized and included in the Teacher Leader candidate’s
assessment of his or her performance. This form is for the use of the candidate and it
does not have to be included in the portfolio.

Name of Teacher Leader Candidate __________________________________________

Teacher Observed: ______________________________Date of Observation _________

Please provide your honest assessment of my performance by responding to the

statements below.

Strongly Disagree Not Agree Strongly

Disagree sure Agree
The tone of the conference was positive and
professional
The candidate’s questions helped me analyze
my own lesson.
The candidate provided specific observation
data to support his or her analysis.
The candidate provided suggestions that
should help me improve my instructional
effectiveness.
My skills of analysis have improved as a
result of this conference
My overall rating of the candidate’s Poor Fair Not Good Excellent
sure
performance is

Answer the following questions:

1. What did you like most about this conference experience?

2. What did you like least about this conference experience?

3. What suggestions can you offer the candidate to improve his or her performance
as a teacher leader

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 Metro RESA Teacher Leader Endorsement Program

SECTION V: REFLECTIONS
The Teacher Leader candidate will write a reflection paper of not more than three
typed pages sharing the insights gained about the process of working with
teachers in his or her role as a teacher leader. In the discussion, the candidate
should identify any legal, ethical issues that he/she experienced. Include a
discussion of the application of technology in the lesson: if no technology was
used, how might technology have been employed to strengthen it? If technology
was employed, was the use appropriate and did it strengthen the lesson? The
candidate should also reflect on his or her experiences in this course, Working
with Teachers to Improve Instruction.

Click or tap here to enter text.

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 Clinical Supervision Cycle Portfolio Rubric

Not evident Emerging Proficient Exemplary Points

0 1-6 7-8 9-10 Earned
Organization of The contents of the portfolio The contents are organized,
Portfolio are not organized into all materials are included,
sections, materials are and sections are clearly
missing, or tapes are not marked.
clearly labeled
Section I: The school description The school description provides The school description The school description is
Establishing the missing or only one data limited information about the provides adequate comprehensive and is based upon a
Context: School source is used. No school environment. Fewer than information about the review of multiple data sources
Description
weaknesses and strengths three data sources are utilized. school environment. At including the School Improvement
are identified least three data sources are Plan, student achievement data for a
utilized. The school’s three-year period, attendance data,
strengths and weaknesses drop-out data, demographic data,
are identified. mobility data, student retention data,
etc. The school’s strengths and
weaknesses have been identified and
are supported by the data.
Section I: The teacher profile is The teacher profile provides The teacher profile is The teacher profile is comprehensive
Establishing the missing. limited information about the adequate but it does not and includes information such as
Context: Teacher teacher. provide a comprehensive number of years in teaching (beginning
Profile view of the teacher. teacher, etc.); number of years at this
school setting; highest degree held;
staff development activities over the
past two years; views about supervision
in general.
Section I: The class profile is missing. The class profile provides The class profile is adequate The class profile is comprehensive and
Establishing the limited information about the but it does not provide includes information such as number of
Context: Class class. a comprehensive review of students, grade level, number of
Profile the class. students with special needs, number of
girls v. boys, ethnicity of students,
socio-economic status of students,
subject, achievement level, etc.)

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 Metro RESA Teacher Leader Endorsement Program

Not evident Emerging Proficient Exemplary Points

0 1-6 7-8 9-10 Earned
Section II: The recording is missing or The recording is audible and The recording is audible and The recording is clearly audible and
Pre-Observation inaudible or the Candidate provides evidence that the provides evidence that the provides evidence that the Candidate is
Conference lacks confidence and does Candidate is somewhat Candidate is knowledgeable confident, knowledgeable of effective
recording not seem knowledgeable. knowledgeable of effective of effective teaching and teaching and coaching strategies, uses
The candidate uses an teaching and coaching strategies. coaching strategies. The the appropriate supervisory style
inappropriate supervisory While the Candidate uses the Candidate uses the effectively, and provides suggestions
style and the conference is appropriate supervisory style, appropriate supervisory that should help the teacher deliver a
ineffective. the conference objective may not style and the conference more effective lesson
have been achieved. objective is achieved.
Section II: The Pre-observation Some of the questions on the All of the questions on the All of the questions on the Pre-
Pre-Observation Conference Form is missing Pre-observation Conference Pre-observation Conference observation Conference Summary form
Conference or some questions are not Summary form are answered and Summary form are are answered and the responses provide
Summary
answered. the responses provide limited answered and the responses compelling evidence that the Candidate
Analysis
evidence that the Candidate is provide clear evidence that is able to analyze the effectiveness of
able to analyze the effectiveness the Candidate is able to the conference and to assess his or her
of the conference. analyze the effectiveness of effectiveness in conducting it. The
the conference. Candidate’s analysis is supported by
the recording.

Section III: The recording of the lesson . The recording of the lesson
Observation is missing, inaudible, or not observed is clear, audible.,
Video Recording clear. and captures the total
classroom environment.
Section III: The Classroom Observation Some of the responses to All questions on the The Classroom Observation Summary
Classroom Summary is missing or the questions on the Classroom Classroom Observation is supported by the recording and the
Observation observation instrument is Observation Summary are Summary are answered. classroom observation data. The
Summary and not attached. missing or observation is Responses are supported by observation summary also provides
classroom
observation
incomplete. the data from classroom evidence that the Candidate is able to
instrument observation. analyze the lesson effectively, prioritize
teaching/learning issues, and engage in
self-analysis.

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 Metro RESA Teacher Leader Endorsement Program

Not evident Emerging Proficient Exemplary Points

0 1-6 7-8 9-10 Earned
Section IV: The recording is inaudible The recording is audible and The recording is audible and The recording is clearly audible and
Post-Observation or missing. provides evidence that the provides evidence that the provides evidence that the Candidate is
Conference Candidate has limited Candidate is somewhat knowledgeable of effective teaching
Recording knowledge of instruction or knowledgeable of effective and coaching strategies, uses the
coaching strategies. Conference teaching and coaching appropriate supervisory style
objectives were not achieved. strategies. effectively, and facilitates a discussion
that should increase the instructional
skills of the teacher.
Section IV: The Post-Observation Some of the questions on the All of the questions on the The Post-Observation Conference
Post-Observation Conference Summary Form Post-observation Conference Post-observation Summary provides compelling
Conference is missing or some questions Summary form are answered and Conference Summary form evidence that the Candidate is able to
Summary are not answered. the responses provide limited are answered and the analyze the effectiveness of the
evidence that the Candidate is responses provide clear conference as well as his or her
able to analyze the effectiveness evidence that the Candidate effectiveness as a teacher leader. The
of the conference. is able to analyze the Candidate is also able to generate
effectiveness of the appropriate next steps.
conference.
Section V: The Reflection Paper is The Reflection Paper provides The Reflections Paper The Reflections Paper provides
Reflections Paper missing. limited evidence that the provides adequate evidence compelling evidence of a thoughtful
Candidate is able to engage in that the Candidate is able to analysis by the Candidate. In this
thoughtful analysis. Problems in engage in thoughtful paper, the Candidate shares meaningful
written communication may also analysis. The discussion of insights gained about the process of
be evident. technology is appropriate. working with teachers. The Candidate
Few, if any, problems in also discusses his or her strengths
written communication are regarding instructional supervision as
noted. well as any legal/ethical issues that he
or she experienced. The discussion of
the application of technology is
insightful and refers to ISTE Standards.
No significant errors in written
communication are noted.

Points Possible = 106 Points Required = 84 Points Earned =

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 Sign-off Form: Working with Teachers to Improve Instruction
Candidate Name: Click or tap here to enter text.
Dates of Course: Click or tap here to enter text.
Instructor: Click or tap here to enter text.

The above-named participant ☐ has ☐ has not completed Working with Teachers to Improve
Instruction satisfactorily as reflected in the Assignment Completion Summary below:

o Attendance: (No more than 5 hours of missed class)

Dates and Hours of class missed: Click or tap here to enter text.
Written make-up work assigned for missed class time: Click or tap here to enter text.
o Non-project reflections completed (10/10 points required): ☐ Yes ☐ No

o Article: The Developmental Stages of Teachers (6 points required)

Total points earned (0-8) Click or tap here to enter text.

o Action Research Proposal (4 points required)

Total points earned (0-4): Click or tap here to enter text.

o Action Research Report (24 points required)

Total points earned (0 -30): Click or tap here to enter text.

o Clinical Supervision Cycle Portfolio (84 points required)

Total points earned (0-106): Click or tap here to enter text.

Total points possible = 158

Total points required = 128 Total points earned: _________________

Instructor’s Signature ___________________ Completion Date: __________________

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