Danielson Evaluation Data Collection
Last, First
Your answer
Tenure Status *
Grade Level
Observed By *
Observation Type *
Observation Number *
Dates of Observations *
MM
/
DD
/
YYYY
Pre-Conference *
If you had a Pre-Conference when was it? *
Pre-Conference Date
MM
/
DD
/
YYYY
Post-Conference *
If you had a Post-Conference did it occur no more than 15 working days following the observation?
Post-Conference Date
MM
/
DD
/
YYYY
Date of Teacher Signature
MM
/
DD
/
YYYY
Date of Observer Signature
MM
/
DD
/
YYYY
Did you receive your written evaluation within 15 teaching days after the observation?
Did you write a response to this evaluation with 10 working days of the post conference/written report (whichever was received last)?
Domain 1
Planning and Preparation *
Unsatisfactory (1)
Basic (2)
Proficient (3)
Distinguished (4)
N/A
1a: Demonstrating Knowledge of Content and Pedagogy
1b: Demonstrating Knowledge of Students
1c: Setting Instructional Outcomes
1d: Designing Coherent Instruction
1e: Designing Coherent Instruction
1f: Designing Student Assessments
Domain 1 Observer Comments
If you received "4-Distinguished" in this domain, please type the observer's commentary. This will allow for EBEA to recognize specific observable actions which can lead to a "4-Distinguished".
Your answer
Domain 1 - Additional Observer Comments
Please type any comments from Domain 1 you feel may be important data.
Your answer
Domain 2
The Classroom Environment *
Unsatisfactory (1)
Basic (2)
Proficient (3)
Distinguished (4)
N/A
2a: Creating an Environment of Respect and Rapport
2b: Establish a Culture for Learning
2c: Managing Classroom Procedures
2d: Managing Student Behavior
2e: Organizing Physical Space
Domain 2 Observer Comments
If you received "4-Distinguished" in this domain, please type the observer's commentary. This will allow for EBEA to recognize specific observable actions which can lead to a "4-Distinguished".
Your answer
Domain 2 - Additional Observer Comments
Please type any comments from Domain 2 you feel may be important data.
Your answer
Domain 3
Instruction *
Unsatisfactory (1)
Basic (2)
Proficient (3)
Distinguished (4)
N/A
3a: Communicating with Students
3b: Using Questioning and Discussion Techniques
3c: SEngaging Students in Learning
3d: Using Assessment in Instruction
3e: Demonstrating Flexibility and Responsiveness
Domain 3 Observer Comments
If you received "4-Distinguished" in this domain, please type the observer's commentary. This will allow for EBEA to recognize specific observable actions which can lead to a "4-Distinguished".
Your answer
Domain 3 - Additional Observer Comments
Please type any comments from Domain 3 you feel may be important data.
Your answer
Domain 4
Professional Responsibilities *
Unsatisfactory (1)
Basic (2)
Proficient (3)
Distinguished (4)
N/A
4a: Reflecting on Teaching
4b: Maintaining Accurate Records
4c: Communicating with Families
4d: Participating in the Professional Community
4e: Growing and Developing Professionally
4f: Showing Professionalism
Domain 4 Observer Comments
If you received "4-Distinguished" in this domain, please type the observer's commentary. This will allow for EBEA to recognize specific observable actions which can lead to a "4-Distinguished".
Your answer
Domain 4 - Additional Observer Comments
Please type any comments from Domain 4 you feel may be important data.
Your answer
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