DCIU DIFFERENTIATED ACTION PLAN
Version For Teaching Professionals
Important Note: Any employee on Differentiated Model of Supervision must move to Focused at minimum -- once in a four year cycle. Therefore, an employee can only be on the Differentiated Model for a maximum of three years before moving back to Focused.
Cycle of Differentiated Supervision: (To be Completed by Evaluator):Year 1 / Year 2 / Year 3
Employee Name: / Date:
Program: / Date Reviewed:
Previous Year’s Evaluation must be proficient in each Domain. Insert ratings that appeared on the previous year’s PDE Form 82.1, Section A-Teacher Observation & Practice:
Title / Rating
[A] / Factor
[B] / Earned Points
[A*B] / Max Points
Domain I- Planning & Preparation / 20% / 0.60
Domain II- Classroom Environment / 30% / 0.90
Domain III- Instruction / 30% / 0.90
Domain IV- Professional Responsibilities / 20% / 0.60
Teacher Observation & Practice Rating / 3.0
Important Note: If at any time the employee’s performance does not demonstrate proficiency or there are any issues of performance, the employee may be moved back to the Focus Model of Supervision at the discretion of the administrator.
Type of Model: Individual or CollaborativeProject: (Must relate to Individual and/or Program-Organizational Goals)
Project Proposal: (How does project relate to goals, what value do you expect it will bring to you, your program/assignment, or improved student achievement?)
Actions: / Estimated Completion Date: / Evidence (artifacts, data, and/or other documentation):
Midyear Project Narrative Assessment: (to be completed by Employee)
Midyear Review: (To be Completed by Evaluator/Employee):
Continue: / Modify: / Move to Focus:
If project is to be modified, what modifications will occur:
Reviewed by: / Date:
Employee’s Signature: / Date:
Administrator’s Signature: / Date:
End of Year Project Narrative Assessment:(to be completed by Employee)
Evaluator’s Comments:
Reviewed by: / Date:
Directions: As the employee is working on the Differentiated Model of Supervision, the employee is deemed to be, at minimum, proficient in each Domain. The administrator will use the ratings from the previous year’s evaluation and insert into chart below.
Current Year’s Evaluation: Insert ratings that will transposed onto the PDE Form 82.1, Section A-Teacher Observation & Practice:Title / Rating
[A] / Factor
[B] / Earned Points
[A*B] / Max Points
Domain I- Planning & Preparation / 20% / 0.60
Domain II- Classroom Environment / 30% / 0.90
Domain III- Instruction / 30% / 0.90
Domain IV- Professional Responsibilities / 20% / 0.60
Teacher Observation & Practice Rating / 3.0
OverallPerformance rating:
Proficient / Distinguished / Needs Improvement / Failing / Resulting in a final rating of:
Satisfactory / UnsatisfactoryFor the next school year, the employee is eligible to:
Continue on Differentiated Model of Supervision: / Move to Focus:
Employee’s Signature: / Date:
Administrator’s Signature: / Date:
*** Attach the completed PDE 82.1 Form to this document.
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