Teacherprofessionalresponsibilitiesand Goal(S) Form

TEACHERPROFESSIONALRESPONSIBILITIESAND GOAL(S) FORM

Teacher School Year

Grade(s) Subject Area(s)

Evaluator

SECTION 1

Complete Section1oftheformandbringwithyou tothe initial

Professional Responsibilities and Goal(s)Conference.

1.1Prioritizestudentneedsandidentifythearea(s)ofneedonwhichyouwill focuswith yourstudentsthisschoolyear.

1.2How willyouensurethatfamiliesandappropriatestaffareinformedof studentarea(s)listedinitem 1.1?

1.3Identifythemeasurableindicator(s) andmethodsofmeasurementyouwillusetoshow studentprogressinitem1.1.

1.4Brieflydescribe your student recordkeeping systemtorecordprogressofitemsidentifiedin1.3.

1.5List professionallearning,including activities and/or coursesthat will help you meetthearea(s)of student needs during thisschool year. Will theseactivitiessupport reflective practice?

1.6List otherinformation thatyou would liketo share with yourevaluator.

DateofConference

Teacher Signature Date

Evaluator Signature Date

November 2015Montana - EPAS Page 1 of 2

TEACHERPROFESSIONALRESPONSIBILITIESAND GOAL(S) FORM

SECTION 2

Before theSummativeConference,completeSection 2oftheform;

provide a copyto yourevaluator. Attachapplicabledocuments.

2.1Summarizeyourstudents’ progressinthearea(s)ofneedasshownby theindicators identifiedinitem1.1.

2.2Ifyou metyour goal(s),whatconditionswere mosthelpful?

2.3Ifyoudidnot meetyourgoal(s), whatwereyourobstaclesorbarriers?

2.4List professionallearning,including activities and/or coursesthat you participated inthis school year. What professional learning helped you meet the identified student needs for this school year? Which of these activities support reflectivepractice?

2.5List curricularor extra-curricularactivities that youfeel have contributedtoyour professional growth. Explain.

2.6List otherinformation thatyou would liketo share with yourevaluator.

TeacherSignature Date

Evaluator Signature Date

DateSubmitted

November 2015Montana - EPAS Page 1 of 2