2015-16 School Effectiveness Review (SER) Appeal Request Form
Key Action and Ratings #1
List the key action and indicator
appealed, the current rating,
and the proposed rating
change.
Key Action: ___________
Current Rating: ______
Proposed Rating: ____
Evidence of Impact
Documents
Describe how the evidence provided aligns with the indicator, the level of
List each document submitted. Label each document with
adoption/implementation and the impact on student performance
the Key Action and indicator appealed and attach to this
and/or professional practice.
form.
Key Action and Ratings #2
List the key action and indicator
appealed, the current rating,
and the proposed rating
change.
Key Action: ___________
Current Rating: ______
Proposed Rating: ____
Evidence of Impact
Documents
Describe how the evidence provided aligns with the indicator, the level of
List each document submitted. Label each document with
adoption/implementation and the impact on student performance
the Key Action and indicator appealed and attach to this
and/or professional practice.
form.
Key Action and Ratings #3
List the key action and indicator
appealed, the current rating,
and the proposed rating
change.
Key Action: ___________
Current Rating: ______
Proposed Rating: ____
Evidence of Impact
Documents
Describe how the evidence provided aligns with the indicator, the level of
List each document submitted. Label each document with
adoption/implementation and the impact on student performance
the Key Action and indicator appealed and attach to this
and/or professional practice.
form.
Key Action and Ratings #4
List the key action and indicator
appealed, the current rating,
and the proposed rating
change.
Key Action: ___________
Current Rating: ______
Proposed Rating: ____
Evidence of Impact
Documents
Describe how the evidence provided aligns with the indicator, the level of
List each document submitted. Label each document with
adoption/implementation and the impact on student performance
the Key Action and indicator appealed and attach to this
and/or professional practice.
form.