Evaluation System

ORANGE BOARD OF EDUCATION

EVALUATION SYSTEM

SUMMATIVE EVALUATION FORM

THERAPEUTIC SPECIALIST

Building: / Date:
Therapeutic Specialist: / Administrator/Evaluator:
Master Content:

*Signature on final page indicates review of the evaluation. Therapeutic Specialist(s) may attach a response to this form. These responses should be sent to Human Resources to become a part of their personnel file.

Directions: Put an “x” under the level which best applies. This summary represents an evaluation of the formative phase. Each domain should be addressed. Please comment under each domain.

LEVEL OF PERFORMANCE

DOMAIN 1: Planning and Preparation / Unsat. / Basic / Prof. / Dist.
Component 1a: Demonstrating knowledge and skill in the specialist therapy area; holding the relevant certificate or license
Component 1b: Establishing goals for the therapy program appropriate to the setting and the students served
Component 1c: Demonstrating knowledge of district, state and federal regulations and guidelines
Component 1d: Demonstrating knowledge of resources, both within and beyond the school district
Component 1e:Planning the therapy program integrated with the regular school program, to meet the needs of individual students
Component 1f: Developing a plan to evaluate the therapy program
Administrator/Evaluator’s Comments:

LEVEL OF PERFORMANCE

DOMAIN 2: The Learning Environment / Unsat. / Basic / Prof. / Dist.
Component 2a: Establishing rapport with students
Component 2b: Organizing time effectively
Component 2c: Establishing and maintaining clear procedures for referrals
Component 2d: Establishing standards of conduct in the treatment center
Component 2e: Organizing physical space for testing of students and providing therapy
Administrator/Evaluator’s Comments:

LEVEL OF PERFORMANCE

DOMAIN 3: Delivery of Service / Unsat. / Basic / Prof. / Dist.
Component 3a: Responding to referrals and evaluating student needs
Component 3b:Developing and implementing treatment plans to maximize students’ success
Component 3c: Communicating with families
Component 3d: Collecting information writing reports
Component 3e: Demonstrating flexibility and responsiveness
Administrator/Evaluator’s Comments:

LEVEL OF PERFORMANCE

DOMAIN 4: Professional Responsibilities / Unsat. / Basic / Prof. / Dist.
Component 4a: Reflecting on practice
Component 4b: Collaborating with teachers and administrators
Component 4c: Maintaining and effective data-management system
Component 4d: Participating in professional community
Component 4e: Engaging in professional development
Component 4f: Showing professionalism including integrity, advocacy, and maintaining confidentiality
Administrator/Evaluator’s Comments:
Data Section:

Please indicate below an overall holistic rating of this evaluation based upon the preponderance of evidence.

Standard Level:

Unsatisfactory Proficient

Basic Distinguished

Attach Professional Improvement Plan (PIP)

Therapeutic Specialist’s signature: / Date:
Administrator/Evaluator’s signature: / Date: