Child Study Team Evaluation Survey
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Name (Optional)
If you feel comfortable, enter your name here. The more information we have, the better database we can build to better help you.
Tenure Status *
Level of Instruction *
Check the level of instruction for this particular evaluation.
School Assignment *
At which school do you teach?  If you teach at multiple schools, check the school where the observation/evaluation took place.
Administrator *
Type the LAST NAME of the administrator that observed/evaluated you.
Observation/Evaluation Number *
Type of Observation *
Pre-Observation Conference Date *
Type "No Conference" if the observation was unannounced, type "Not Offered" if a pre-observation conference was not offered by the administrator for an announced observation, and "Waived Conference" if you voluntarily waived your legal right to a pre-observation conference for an announced observation.
Observation/Evaluation Date *
MM
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DD
/
YYYY
Observation/Evaluation Overall Score *
Domain One: Planning and Preparation *
Please click the buttons to match your written observation/evaluation.
Highly Effective
Effective
Partially Effective
Ineffective
N/A
A. Demonstrates knowledge and skill in using academic achievement instruments to evaluate students *Knowledge of Assessments
B. Demonstrates knowledge of student learning through the establishment of initial academic goals and recommended education programs. *Child Development *Learning Process *Special Needs *Students skills, knowledge, and proficiency
C. Planning the educational program integrated with the regular school program to meet the needs of individual students in the least restrictive environment. *Knowledge of students *Knowledge of Programs
D. Demonstrating knowledge of state and federal regulations related to special education. *Knowledge of Federal Code *Knowledge of NJ Administrative Code
Domain Two: The Environment *
Please click the buttons to match your written observation/evaluation.
Highly Effective
Effective
Partially Effective
Ineffective
N/A
A. Establishing rapport with students within the school environment. *Interactions with students
B. Demonstrating knowledge of strategies and interventions at the prereferral level. *Expectations for learning and achievement
C. Organizing physical space for testing of students and storage of materials. *Safety and accessibility *Arrangement of furniture and resources
Domain Three: Delivery of Service *
Please click the buttons to match your written observation/evaluation. .
Highly Effective
Effective
Partially Effective
Ineffective
NA
A. Responding to referrals; consulting with teachers and administrators. *Interaction with teachers and administrators *Knowledge of procedures *Knowledge of Criteria *Knowledge of Resources
B. Collaborates with the members of the Child Study Team. *Effective Communication and Collaboration Techniques *Discussion techniques
C. Maintaining contact with teachers for the planning of interventions to maximize students' likelihood of success. *Knowledge of students' strengths and weaknesses *Knowledge of strategies *Discussion techniques
D. Demonstrating flexibility and responsiveness. *Responding to students' needs
Domain Four: Professional Responsibilities *
Please click the buttons to match your written observation/evaluation.
Highly Effective
Effective
Partially Effective
Ineffective
NA
A. Reflecting on practice. *Accuracy *Use in future practices
B. Communicating with families. *About instructional program *About individual students *Engagement of families in instructional programs
C. Maintaining accurate records. *Maintaining confidentiality
D. Engaging in professional development *Enhancement of assessment knowledge and skill
E. Showing professionalism. *Integrity/ethical conduct *Services to students *Advocacy *Decision-making *Compliance with school/district regulations
Observer/Evaluator Narrative Comments  
Enter any noteworthy comments written by your observer/evaluator on your observation/evaluation.  
Overall Evaluation Score
Post-Observation Conference Date/Time *
Enter the date and time of your post-observation conference. The conference should be held during prep time, during a duty, or during release time given to you by your principal.  Type "No Conference" if a post-observation conference did not take place.
Was your conference held in a private place where you could not be overheard by students, parents, or colleagues? *
During what time was the conference held? *
Date of Observer/Evaluator Signature *
MM
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DD
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YYYY
Time
:
Date of Teacher Signature *
MM
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DD
/
YYYY
Time
:
Response Submitted *
Did you submit a response to the administrator who observed you? This can be done via email or hard copy.
Member's Additional Comments  
Comments should reflect specific items and/or comments noted on the observation/evaluation or that were discussed during the pre- and/or post-observation meeting.    
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