Appendix A - Forms for Falmouth Educator Evaluation
Educator Plan Development - Combined Form
Educator—Name/Title:
Primary Evaluator—Name/Title:
School(s):
Analysis of Student Learning
Briefly summarize areas of strength and high-priority concerns for students under your responsibility for
the upcoming school year. Cite evidence such as results from available assessments.
603 CMR 35.06 (2)(a)1
Assessment of Practice Against Performance Standards
Citing your district’s performance rubric, briefly summarize areas of strength and high-priority areas for
growth. Areas may target specific Standards, Indicators, or Elements, or span multiple Indicators or
Elements within or across Standards. 603 CMR 35.06 (2)(a)2
Appendix A – Educator Plan Development - Combined Form
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Appendix A - Forms for Falmouth Educator Evaluation
Educator Plan Development - Combined Form
Check applicable box:
This is a:
Proposed SMART Goal1
Revised SMART Goal2
Final Goal
Individual Goal
TEAM Goal
Date
Date
Date
Evaluator's Signature
List Team Members below:
Every Educator must submit a minimum of two SMART Goals - one or both may be a TEAM goal. This
page is for the Student Learning goal, which must be connected to a change in Professional Practice.
Student Learning Goal
State the change in professional practice that will lead to improved student learning.
1If
proposed goals are approved as written, the evaluator will check the Final goals box and date.
2If
goals need to be revised during Plan Development; the revised goals should be recorded on a new
sheet and attached to the original goals. If proposed goals are approved as written, a separate sheet is
not required.
Appendix A – Educator Plan Development - Combined Form
June 2013
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Appendix A - Forms for Falmouth Educator Evaluation
Educator Plan Development - Combined Form
Check applicable box:
This is a:
Individual Goal
Proposed SMART Goal1
Date
Revised SMART Goal2
Date
Final Goal
Date
TEAM Goal
Evaluator's Signature
List Team Members below:
Every Educator must submit a minimum of two SMART Goals - one or both may be a TEAM goal. This
page is for the Professional Practice goal, which may be either a stand-alone goal for Professional
Practice or a goal that is also connected to student learning.
Professional Practice Goal
State the stand-alone professional practice goal,
or a second change in professional practice that will lead to improved student learning .
1If
proposed goals are approved as written, the evaluator will check the Final goals box and date.
2If
goals need to be revised during Plan Development; the revised goals should be recorded on a new
sheet and attached to the original goals. If proposed goals are approved as written, a separate sheet is
not required.
Appendix A – Educator Plan Development - Combined Form
June 2013
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Appendix A - Forms for Falmouth Educator Evaluation
Educator Plan Development - Combined Form
Educator Plan:
Plan Duration:
Self-Directed Growth Plan
Developing Educator Plan
Two-Year
One-Year
Directed Growth Plan
Improvement Plan
Less than a year
Educator Plan
Describe the Action Steps needed to attain the Student Learning Goal, and the Benchmarks that
demonstrate progress toward the goal
Action
Supports/Resources from
School/District1
Timeline or
Frequency
Expected
Evidence
Educator Plan
Describe the Action Steps needed to attain the Professional Practice Goal, and the Benchmarks that
demonstrate progress toward the goal
Action
Supports/Resources from
School/District1
Timeline or
Frequency
Expected
Evidence
This Educator Plan is "designed to provide educators with feedback for improvement,
professional growth, and leadership," is "aligned to statewide standards and Indicators in 603
CMR 35.00 and local Performance Standards," and "is consistent with district and schools goals."
(see 603 CMR 35.06 (3)(d) and 603 CMR 35.06(3)(f).)
Signature of Evaluator
Date
Signature of Educator
Date
*As the Evaluator retains final authority over goals to be included in an Educator's plan (see 603 CMR 35.06(3)(c)),
the signature of the Educator indicates that he or she has received the Goal Setting Form with the "Final Goal" box
checked, indicating the Evaluator's approval of the goals. The Educator's signature does not necessarily denote
agreement with the goals. Regardless of agreement with the final goals, signature indicates recognition that "It is the
Educator's responsibility to attain the goals in the plan and to participate in any trainings and professional
development provided through the state, district, or other providers in accordance with the Educator Plan." (see 603
CMR 35.06(4)) 1 Must identify means for educator to receive feedback for improvement per 603 CMR 35.06(3)(d)
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June 2013
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