WESTERN OREGON UNIVERSITY
Special Educator Program
Form J
Revised:
06/27/15
Work Sample Evaluation
*
*
SpEd 609 Practicum: Academic
Student:
SpEd 610 Internship: Academic
Evaluated by:
One
Work Sample:
*
Reading
*
Date Evaluated:
Math
Components of the Work Sample are rated as follows:
N/I = Not Included 0 = Does Not Meet Standard (DN) 1 = Developing Proficiency Toward Standard (DP) Component
2 = Proficient Relative to Standard (PR) Rating
Title Page & Table of Contents
Introduction
Y
N
/3 or __
(1)
Setting
0
1
Classroom Layout
0
1
Resources Inventory
0
1
Educational Intervention Plans
(2)
/60 or __
Student Identifying & Background Information
N/I 0 1 2 3
Pre-test Results & Discussion
N/I 0 1 2 3
Post-test Results & Discussion
N/I 0 1 2 3
Overview of Intervention Plan
N/I 0 1 2 3
Long-term Goals & Short-term Objectives #1
N/I 0 1 2 3
Instructional/Remedial Methods
N/I 0 1 2 3
Description of Data Gathering Procedures
N/I 0 1 2 3
Data-based Analysis of Intervention(s)
N/I 0 1 2 3
Data Charts & Graphs
N/I 0 1 2 3
Long-term Goals & Short-term Objectives #2
3 = Exceeds Standard (ES) Comments
N/I 0 1 2 3
Instructional/Remedial Methods
N/I 0 1 2 3
Description of Data Gathering Procedures
N/I 0 1 2 3
Data-based Analysis of Intervention(s)
N/I 0 1 2 3
Data Charts & Graphs
N/I 0 1 2 3
Long-term Goals & Short-term Objectives #3
N/I 0 1 2 3
Instructional/Remedial Methods
N/I 0 1 2 3
Description of Data Gathering Procedures
N/I 0 1 2 3
Data-based Analysis of Intervention(s)
N/I 0 1 2 3
Data Charts & Graphs
N/I 0 1 2 3
Summary of Findings
N/I 0 1 2 3
Recommendations
(3)
/ 6 or __
School
N/I 0 1 2 3
Parents
N/I 0 1 2 3
Appendices
Planning
(4)
/12 or __
Weekly Schedules
N/I 0 1 2 3
Daily/Weekly lesson plans
N/I 0 1 2 3
Self-evaluation of lessons
N/I 0 1 2 3
WIGLs
N/I 0 1 2 3
Student Work
(5)
/9 or __
Pre-test materials
N/I 0 1 2 3
Instructional probes/products
N/I 0 1 2 3
Post-test materials
N/I 0 1 2 3
(1)
(2)
(3)
(4)
(5)
___
___
___
___
___
Grade for Work Sample 1
_____ %
b
___ / 90 or ____
Grade for Work Sample 2
_____ %
b
___ / 90 or ____
Observation 1 = ___ / 90 or ___
Grade for FE Teaching
_____ %
b
____ / ____
Observation 2 = ___ / 90 or ___
Grade for Competencies
_____ %
b
____ / 132 or ____
Observation 3 = ___ / 90 or ___
TOTAL:
_____ % / 4 = ______ %
b
_____ / _____
[ FINAL GRADE = _____
WESTERN OREGON UNIVERSITY
Special Educator Program
Form J
Revised:
06/27/15
Work Sample Evaluation
*
*
SpEd 609 Practicum: Academic
Student:
SpEd 610 Internship: Academic
Evaluated by:
Two
Work Sample:
*
*
Reading
Date Evaluated:
Math
Components of the Work Sample are rated as follows:
N/I = Not Included 0 = Does Not Meet Standard (DN) 1 = Developing Proficiency Toward Standard (DP) Component
2 = Proficient Relative to Standard (PR) Rating
Title Page & Table of Contents
Introduction
Y
N
/3 or __
(1)
Setting
0
1
Classroom Layout
0
1
Resources Inventory
0
1
Educational Intervention Plans
(2)
/60 or __
Student Identifying & Background Information
N/I 0 1 2 3
Pre-test Results & Discussion
N/I 0 1 2 3
Post-test Results & Discussion
N/I 0 1 2 3
Overview of Intervention Plan
N/I 0 1 2 3
Long-term Goals & Short-term Objectives #1
N/I 0 1 2 3
Instructional/Remedial Methods
N/I 0 1 2 3
Description of Data Gathering Procedures
N/I 0 1 2 3
Data-based Analysis of Intervention(s)
N/I 0 1 2 3
Data Charts & Graphs
N/I 0 1 2 3
Long-term Goals & Short-term Objectives #2
3 = Exceeds Standard (ES) Comments
N/I 0 1 2 3
Instructional/Remedial Methods
N/I 0 1 2 3
Description of Data Gathering Procedures
N/I 0 1 2 3
Data-based Analysis of Intervention(s)
N/I 0 1 2 3
Data Charts & Graphs
N/I 0 1 2 3
Long-term Goals & Short-term Objectives #3
N/I 0 1 2 3
Instructional/Remedial Methods
N/I 0 1 2 3
Description of Data Gathering Procedures
N/I 0 1 2 3
Data-based Analysis of Intervention(s)
N/I 0 1 2 3
Data Charts & Graphs
N/I 0 1 2 3
Summary of Findings
N/I 0 1 2 3
Recommendations
(3)
/ 6 or __
School
N/I 0 1 2 3
Parents
N/I 0 1 2 3
Appendices
Planning
(4)
/12 or __
Weekly Schedules
N/I 0 1 2 3
Daily/Weekly lesson plans
N/I 0 1 2 3
Self-evaluation of lessons
N/I 0 1 2 3
WIGLs
N/I 0 1 2 3
Student Work
(5)
/9 or __
Pre-test materials
N/I 0 1 2 3
Instructional probes/products
N/I 0 1 2 3
Post-test materials
N/I 0 1 2 3
Grade for Work Sample 2
Additional Comments:
_____ %
b
___ / 90 or ____
b
(1)
(2)
(3)
(4)
(5)
___
___
___
___
___