Office of Field Services Practicum Record and Evaluation Form

OFFICE OF FIELD SERVICES PRACTICUM RECORD AND EVALUATION FORM

INTERN:______EXP: ST EST PR EST 371 371 SCHOOL______SEMESTER/YEAR______

GRADE LEVEL/SUBJECT______

This form is to inform intern, mentor and supervisor of Intern’s progress on assignments and observations throughout semester. Supervisor is to returned Completed Form to OFS at end of semester.

Rubrics in Taskstream DRFs are used to determine Scores on assignments. Final scores are to be recorded here. **OBR Modules are not scored by supervisor A DESCRIPTION TASKSTREA SCORE SS (A SCORE OF “2” IS CONSIDERED PROFICIENT) M (0-3) DRF IG Context for Learning OFS N Student Profiles: Students as Learners OFS M Instructional Videotaping LICENSUR E E N Teacher Work Sample LICENSUR TS E Post-observation reflections OFS See Below * SPA Requirements Above OB 4 MODULE Quizzes** All submitted to Student Completed R (PRACTICUM) Manager, Cleveland State YES NO Taskstream OFS DRF

Complete information for each Observation O Taskstream BS DATE/TIME Walk LESSON PLAN COMMENTS 1 Last Revised : 8/19/16 ER Through OR Score Completed Observation Met/ Not Met V OBS Met Not Met Met Not AT Met IO OBS Met Not Met Met Not N Met S OBS Met Not Met Met Not Met OBS Met Not Met Met Not Met W/T OBS Met Not Met Met Not Met W/T OBS Met Not Met Met Not Met

TR DATE OF MEDIATED SCORE

IA TRIAD Midte DS rm Final

Please circle type of letter completed for intern by Mentor and Supervisor

MENTOR LETTER SUPERVISOR LETTER RECOMMENDATION Letter or RECOMMENDATION Letter or COMPLETION Letter COMPLETION Letter

SIGNATURES:

INTERN:______(DATE)

MENTOR:______(DATE)

SUPERVISOR:______2 (DATE) Description GRADE % of Final Grade FINAL ASSIGNMENTS 40% GRAD E CANDIDATE PRE-SERVICE ASSESSMENT 40% TOTA OF LS STUDENT TEACHING (CPAST) C.O.E.H.S./SPA 20% Final Grade for Semester Grade Calculator can be found on OFS website

GRADE KEYS ASSIGNMENTS GRADE KEY OBSERVATIONS AND FINAL GRADE Grade Points or% A >1.64 A- 1.63-1.52 B+ 1.51-1.40 B 1.39-1.28 B- 1.27-1.16 C+ 1.15-1.04 C 1.03-0.92 D 0.91-0.80 F 0.79>

Grade Points or % A >2.14 A- 2.13-2.02 B+ 2.01-1.90 B 1.89-1.78 B- 1.77-1.66 C+ 1.65-1.54 C 1.53-1.42 D 1.41-1.30 F 1.29 >

3 Last Revised : 8/19/16 4