Pre-Service Performance Assessment For Practicum/Practicum Equivalent Professional Standards For Teachers: See 603 CMR 7.08

Candidates Name Britany Gage
Pre-service Performance Assessment for Practicum/Practicum Equivalent

Professional Standards for Teachers: See 603 CMR 7.08
Please use this assessment in conjunction with the Pre-service Performance Assessment for Teachers guidelines:
the rating scale; evaluation questions relating to the standards; and the license-specific questions per standard
(b)2c. Candidates must complete the Evidence column for evaluation by the program supervisor and supervising
practitioner.
Standard A - Plans Curriculum and Instruction

Indicators
1.
Evidence
Draws on content standards of the relevant curriculum

frameworks to plan sequential units of study, individual
lessons, and learning activities that make learning
cumulative and advance students level of content
knowledge. (Specify Curriculum Framework title, learning
standards, and concept and skills used [attach list if
necessary]).
2.
Draws on results of formal and informal assessments as

well as knowledge of human development to identify
teaching strategies and learning activities appropriate to
the specific discipline, age, level of English language
proficiency, and range of cognitive levels being taught.
3.
Identifies appropriate reading materials, other

resources, and writing activities for promoting further
learning by the full range of students within the
classroom.
MA CF Physical Health Strand & SHAPE

standards cited in all LP (Lesson Plan
Section) SHAPE S3.E1.2/3, S4, E4.3a,
S1.E6.2/3, S1. E17.2/3,
MA CF written on whiteboard for every
class (miscellaneous section) MA CF
2.2,2.4,2.7
Unit plan consisting of unit outcomes,
national & state standards, content
knowledge, assessments, and unit
evaluation system of a soccer unit (unit
plan section)
Quiz given to students on the final day of
the soccer unit covering all skills.
(miscellaneous section)
SP notes on 9/23 Goffs Class excellent
closure to your classes. You provided a
nice review of the information you
provided at the beginning of the game.
(observation section)
Pre-Assessment given to students before
beginning soccer unit. ( unit plan section)
Word wall used during soccer and games
from around the world unit-identifies key
words to be used during the unit
Assessment given to students about skill
cues for dribbling a soccer ball (student
work)
Lice worksheet given to the students
during the health week ( assessment
section)
KWL chart used for the beginning of the
lice lesson (miscellaneous section)
4.
Identifies prerequisite skills, concepts, and vocabulary

needed for the learning activities and design lessons that
strengthen student reading and writing skills.
5.
Plans lessons with clear objectives and relevant

measurable outcomes.
6.
Draws on resources from colleagues, families, and the

community to enhance learning.
7.
Incorporates appropriate technology and media in lesson

planning.
8.
Uses information in Individualized Education Programs

(IEPs) to plan strategies for integrating students with
disabilities into general education classrooms.
Vocabulary word wall for Games from

Around the World. Key words that will be
important to know before the end of the
unit. (miscellaneous section)
Pre-assessment given to students before
soccer unit (unit plan section)
All LPs have measureable objectives in all
3 domains, including criteria, condition,
content and behavior (Lesson Plan
Section)
SPs midterm feedback All lesson plans
are well written and reflect a well
throughout lesson (observation section)
CS midterm feedback multiple citings in
all lessons, well written and pre-planning
evident (observation section)
Attended Fall Open House to meet and
talk with students families
Attended faculty meeting that discussed
strategies on how to deal with students
that have ADHD (miscellaneous section)
SPs midterm feedback excellent
collaboration with physical therapist
Use PowerPoint to show Country for
Games from Around the World unit.
(miscellaneous Section)
Video shown to students on bus safety
(lesson plan section)
Use of computers during lice unit
www.headlice.org. (lesson plan section)
LP 9/22 Soccer unit uses music for stop
and go signals.( lesson plan section)
Special/Safety Considerations sections
on all LPs based on the IEPs (lesson plan
section)
Attended faculty meeting where
strategies for dealing with ADHD children
were discussed (miscellaneous section)
Read IEPs for grade 2 and took down
special notes for each class. (journal
section)
Gave student with visual impairment an
enlarged worksheet so he was able to
see. (miscellaneous section)
9.
Uses instructional planning, materials, and student

engagement approaches that support students of
diverse cultural and linguistic backgrounds, strengths,
and challenges.
Rating:
LP 9/11 included opportunities for

student to discuss prior experiences to
engage students and help them make
connections between the topic and their
own experiences (lesson plan section)
SPs midterm feedback good use of
demonstrations and white board
Explanation of Rating for Standard A - Plans Curriculum and Instruction:
Rating Scale: 1=Does Not Meet the Standard; 2=Meets the Standard, 3=Exceeds the Standard; NA=Not Applicable.
Candidates Name:
License:
Program Supervisor (initial):
Date:
Supervising Practitioner (initial):
Date:

Standard B Delivers Effective Instruction
Indicators
Evidence
1. Communicates high standards and expectations when
beginning the lesson.

a.
Makes learning objectives clear to students.
b.
Communicates clearly in writing, speaking and through

the use of appropriately designed visual and
contextual aids.
c.
Uses engaging ways to begin a new unit of study or

lesson.
d.
Builds on students prior knowledge and experience.
MA CF standards written on white board

for every class (miscellaneous section)
SP observation on 9/17 I love the way
you are following thru with your
expectations- awesome! (observation
section)
SP notes on 9/26 Robinsons class I liked
how you reviewed the expectations
several times. By asking student to
repeat back directions. You are allowing
all students to hear them again. (
miscellaneous section)
All journal conversations with CS (journal
section)
Word wall used for all activities
SPs midterm feedback good use of
demonstrations and white board
Pre-assessment given on first day of
soccer unit to see what students played
soccer and how they felt about it
(assessment section)
Games from around the world unit intro,
showing student pictures of the flags and
food from different countries on power
points ( Lesson plan section)
Sequencing in soccer unit builds on
complexity each day ( Unit Plan Section)
Pre-Assessment given to students
before soccer unit started to see where
each student is at. (Lesson Plan Section)
nd
Asking 2 grade students if they have
ever visited the country our game was
from and what they knew about the
country. (lesson plan section)
carrying out the lesson.

a.
Uses a balanced approach to teaching skills and

concepts of elementary reading and writing.
b.
Employs a variety of content-based and contentoriented teaching techniques from more teacherdirected strategies such as direct instruction, practice,
and Socratic dialogue, to less teacher-directed
approaches such as discussion, problem solving,
cooperative learning, and research projects (among
others).
c.
Quiz given at the end of the soccer unit

that was read aloud to the students by
the teacher. (unit plan section)
Lice fill in the blank worksheet the
students completed after lice class.
Talked with students about ways they
can improve their safety on the bus.
LP 9/22 Give the student a choice of the
size of goal they wanted and how far
away they would like to shoot during the
soccer unit. (Lesson plan section)
Lice fill in the blank worksheet the
students completed individually after lice
lesson. (lesson plan section)
Demonstrates an adequate knowledge of and

approach to the academic content of lessons. (See
attached documentation that demonstrates license-specific
questions were used to evaluate candidate knowledge)
Physical Education license-specific questions:
1. Demonstrates an adequate knowledge of the

principles of health-related fitness and nutrition.
2. Uses knowledge of motor development (growth and

development) when developing and modifying
lessons.
3. Demonstrates an adequate knowledge of the

history and foundations of physical
education/kinesiology (e.g., exercise physiology,
biomechanics, psycho-social aspects of play and
sport, history of physical education).
4. Demonstrates an adequate knowledge of

movement concepts, skill themes, and sports
concepts.
SPs notes on 9/26 warm-up was quick

and efficient in warming them up.
All LPs Stretching done before all
activities. (lesson plan section)
Sit and Reach performed with all
students as part of the Fitness
Gram.(miscellaneous section)
Games from Around the World LP 9/24
Locomotor movements used for the
students to travel from one place to
another. (Lesson Plan Section)
All LPs have extensions used for
modifying lessons to students abilities
Skill cues for soccer dribbling- LP 9/8
(Lesson Plan Section)
LPs on 9/11 and 9/22 working with
partners- social aspects of play (lesson
plan section)
LP on 9/15 non-kicking foot next to the
ball, use the inside of your foot when
kicking, Follow through with your kicking
foot towards your target (Lesson Plan
Section)
All LPs during soccer unit- broke down
individual skills using simple skill cues
5. Demonstrates an adequate knowledge of a range of

appropriate play and sports for PreK-12 and the
relevant motor skills.
6. Demonstrates knowledge of appropriate physical

and safety limitations, legal standards, tort liability,
first aid and Cardiac Pulmonary Resuscitation (CPR)
when conducting a lesson.
7. Demonstrates an adequate knowledge of

adaptations for students with disabilities.
8. Refers to appropriate learning standards in the

Comprehensive Health Curriculum Framework in
developing a lesson.
d.
Employs a variety of reading and writing strategies for

addressing learning objectives.
e.
Uses questioning to stimulate thinking and encourages

all students to respond.
f.
Uses instructional technology appropriately.
Progression through the soccer unit (Unit

Plan Section)
SP observation on 9/17 Tunnel Taggood choice of a warm-up for this
grade/age Students loved the warmup (observation section)
All LPs during all units- safety is
discussed. (lesson plan section)
Observation by SP on 10/1 great job
including safety in your lessons.
Special Considerations section under all
LPs (lesson plan section)
Reviewed IEPs with SP and made notes
to help us with adaptations (journal
section)
State frameworks cited on all LPs (lesson
plan section)
MA CF standards written on whiteboard
before every unit. (miscellaneous
section)
Read quiz aloud during the soccer unit to
the students in each class. (lesson plan
section)
Skill cues written on whiteboard for
goalkeeping during the soccer unit.
Read Quiz and worksheets outloud to
the students while they are completing
them. (lesson plan section)
SPs notes on 9/16 Dangelis class nice
review of last class and discussion on
passing (miscellaneous section)
SPs notes on 9/15 Robinsons Class nice
closure what did you learn about
passing today? (miscellaneous section)
Uses music as start and stop signal LP
9/22 (lesson plan section)
Uses power point to display each
Country for Games from Around the
World unit.(lesson plan section)
Website used for lice lesson. (lesson plan
section)
g.
Uses effective strategies and techniques for making

content accessible for English language learners.
h.
Demonstrates knowledge of the difference between

social and academic language and the importance of
this difference in planning, differentiating and
delivering effective instruction for English language
learners at various levels of English language
proficiency and literacy.
extending and completing the lesson.

a.
Assigns homework or practice that furthers student

learning and checks it.
b.
Provides regular and frequent feedback to students on

their progress.
c.
Provides many and varied opportunities for students

to achieve competence.

evaluating student learning.
a.
Accurately measures student achievement of, and

progress toward, the learning objectives with a variety
of formal and informal assessments, and uses results
to plan further instruction.
CS observation on 9/25 reviewed

specific skills and Q + A used before each
task (observation section)
SPs midterm evaluation-good use of
demonstrations (observation section)
SPs notes on 9.23 Dont forget to
continue to use modeling of how you
want things done , visual for visual
learners (miscellaneous section)
Language objectives used for ELL
students in grade 3. (lesson plan section)
SP observation on 9/17 areas of strength
use of demo and checking for
understanding. (observation section)
Optional homework given to grade 3

students during the soccer unit (unit plan
section)
All assessments given during soccer unit.
(unit plan section)
Lice worksheet brought home to show
parents what they learned in PE class
SP notes on 9/18 Mrs. Robinsons class
Nice job visiting each group and checking
in with them-continuing to provide
feedback (observation section)
CS observation on 9/26 good
corrections and specific feedback
LPS during soccer unit all provided
extensions (unit plan section).
SP midterm evaluation consistently
uses and effective delivery-checking for
understanding (observation section)
Pre-Assessment given to all students

before beginning soccer unit (unit plan
section)
Quiz given to students at the closure of
the soccer unit (unit plan section)
Informal assessment done through
questioning at beginning/ end of each
class during soccer unit. (unit plan
section)
CS observation on 9/25 Asked
questions and reviewed outcomes
b.
Translates evaluations of student work into records

that accurately convey the level of student
achievement to students, parents or guardians, and
school personnel.
Rating:
Attended open house where there was

communication with parents about their
children (picture section)
Summative Assessment- given at the end
of the soccer unit (unit plan section)
Explanation of Rating for Standard B Delivers Effective Instruction:
Candidates Name:
License:
Date:
Date:

Standard C Manages Classroom Climate and Operation
Indicators
Evidence
1.
Creates and maintains a safe and collaborative learning

environment that values diversity and motivates students
to meet high standards of conduct, effort and
performance.
2.
Creates a physical environment appropriate to a range of

learning activities.
3.
Maintains appropriate standards of behavior, mutual

respect, and safety.
4.
Manages classroom routines and procedures without loss

of significant instructional time.
10
SP notes on 9/10 Mrs. Bartolomeis

class Much better adding safety
concerns for movement and booping.
SP observation 10/1 Areas of Strength
positive attitude for the students
Behavior chart used for every class.
Students are given a score for the
overall class every time they are in PE.
(picture section)
LP 9/22 Give the student a choice of
the size of goal they wanted and how
far away they would like to shoot
during the soccer unit. (Lesson plan
section)
All activities have extensions to adjust
to students needs. (Lesson plan
section)
Behavior chart used for every class.
Students are given a score for the
overall class every time they are in PE.
Observation by SP on 10/1 great job
including safety in your lessons.
SP midterm evaluation Students
consistently demonstrate appropriate
standards of respect, safety and
behavior. (observation section)
Rules of the classroom written on the
wall (miscellaneous section)
Observation by CS on 9/11- Good
overall class management Good
Flow and transitions (observation
section)
SP midterm evaluation manages
classroom routines and procedures
without a significant loss of
instructional time (observation
section)
Observation by CS on 9/26 Has
excellent class management (
observation section)
Rating:
Explanation of Rating for Standard C - Manages Classroom Climate and

Operation:
Candidates Name:
License:
Date:
Date:

Standard D Promotes Equity
Indicators
Evidence
1.
Encourages all students to believe that effort is a key to

achievement.
2.
Works to promote achievement by all students without

exception.
3.
Assesses the significance of student differences in home

experiences, background knowledge, learning skills,
learning pace, and proficiency in the English language for
learning the curriculum at hand and uses professional
judgment to determine if instructional adjustments are
necessary.
11
SP notes on 9/8 Mr. Lyons class much

better job providing encouragement
and interacting with students during
jogging warm-up. (observation
section)
LP Soccer having students see if they
can beat a previous score. (lesson plan
section)
SP midterm evaluation works to
promote achievement in all students
SP midterm evaluation avoids
stereotyping (observation section)
Special considerations section on all
LPS (lesson plan section)
SP midterm evaluation provides
support to struggling students in preteaching group. (observation section)
4.
Helps all students to understand American civic culture,

its underlying ideals, founding political principles and
political institutions, and to see themselves as members
of a local, state, national, and international civic
community.
5.
Collaborates with families, recognizing the significance of

native language and culture to create and implement
strategies for supporting student learning and
development both at home and at school.
Rating:
Students doing pledge of allegiance

every day in class with myself
Rules of the classroom written on the
wall (miscellaneous section)
Attended open house at the beginning

of the year to meet students families
Optional homework sent home during
the soccer unit (miscellaneous section)
Sends sneaker reminders home for
parents if a student forgets theirs for
PE (Miscellaneous Section)
Explanation of Rating for Standard D- Promotes Equity:
Rating Scale: 1=Does Not Meet the Standard; 2=Meets the Standard, 3=Exceeds the Standard; 4=NA/Not Applicable.
Candidates Name:
License:
Date:
Date:

Standard E Meets Professional Responsibilities
Indicators
Evidence
12
1.
Understands his or her legal and moral responsibilities.
2.
Conveys knowledge of and enthusiasm for his/her

academic discipline to students.
3.
Maintains interest in current theory, research, and

developments in the academic discipline and exercises
judgment in accepting implications or findings as valid
for application in classroom practice.
4.
Collaborates with colleagues to improve instruction,

assessment, and student achievement.
5.
6.
Works actively to involve parents in their childs

academic activities and performance, and
communicates clearly with them.
Reflects critically upon his or her teaching experience,

identifies areas for further professional development
as part of a professional development plan that is
linked to grade level, school, and district goals, and is
receptive to suggestions for growth.
13
MA CF Physical Health Strand, NASPE

standards, and safety consideration
cited in all LPS (Lesson Plan Section)
SP midterm evaluation understands
and applies moral as well as legal
responsibilities (observation section)
SP notes on 9/23 Mrs. Goffs class
Good job providing personal feedback
and enthusiasm to this game.
SP observation on 10/1 Areas of
strength positive attitude
Use of a variety of resources on all LPS
SP midterm evaluation has taken
advantage of professional
development opportunities
Attended professional development
during early dismissal days (journal
section)
All journal entries/ conservations with
CS (journal section)
All observations with feedback from CS
and SP (observation section)
SP midterm evaluation excellent
collaboration with physical therapist
Attended professional development
during early dismissal days (journal
section)
Sends sneaker reminders home for
parents if a student forgets theirs for
PE (Miscellaneous Section)
Lice worksheet brought home to show
parents what they learned in PE class
Reflection column/notes on all LP
(Lesson Plan section)
All Journal entries reflect critically
upon teaching for the day. (Journal
section)
7.
Understands legal and ethical issues as they apply to

responsible and acceptable use of the Internet and
other resources.
Rating:
Cites all internet and book resources

on all LPs (Lesson Plan Section)
SP midterm evaluation understands
and applies moral as well as legal
responsibilities (observation section)
Explanation of Rating for Standard E Meets Professional Responsibilities:
Candidates Name:
License:
Date:
Date:
14

Summary Decision for Pre-service Performance Assessment

To be completed and agreed upon by both the supervising practitioner and the program supervisor
Teacher candidates Pre-service Performance Assessment in the practicum/practicum

equivalent meets the Professional Standards for Teachers:
Yes
No
Candidate (sign):
MEPID:
Program Supervisor (sign):
Date:
Supervising Practitioner (sign):
Date:
or License #:
Teaching Ability (on the floor) Grade_________
Final Practicum Grade ____________
(Supervising Practitioner & College Supervisor collaborate)
(Includes all written assignments. CS determines final grade)
Standard
Standard A- Plans Curriculum and Instruction
Standard B- Delivers Effective Instruction
Standard C- Manages Classroom Climate and Operation
Standard D- Promotes Equity
Standard E- Meets Professional Responsibilities
Rating
Summary Assessment of Performance (include phrases that could be used in a letter of recommendation):
Areas of strength:
Areas in need of improvement:
15

Standard (b)2c
Demonstrates adequate knowledge of and approach to the academic content of lessons.
Physical Education (PreK-8)(5-12)

Evidence
Found
Evidence Not
Found
License-Specific Evaluation Questions

Does the candidate demonstrate an adequate knowledge of the
principles of health-related fitness and nutrition?
Does the candidate use knowledge of motor development (growth
and development) when developing and modifying lessons?
Does the candidate demonstrate an adequate knowledge of the
history and foundations of physical education/kinesiology (e.g.,
exercise physiology, biomechanics, psycho-social aspects of play and
sport, history of physical education)?
Does the candidate demonstrate an adequate knowledge of
movement concepts, skill themes, and sports concepts?
Does the candidate demonstrate an adequate knowledge of a range
of appropriate play and sports for PreK-12 and the relevant motor
skills?
Does the candidate demonstrate knowledge of appropriate physical
and safety limitations, legal standards, tort liability, first aid and
Cardiac Pulmonary Resuscitation (CPR) when conducting a lesson?
Does the candidate demonstrate an adequate knowledge of
adaptations for students with disabilities?
Does the candidate refer to appropriate learning standards in the
Comprehensive Health Curriculum Framework in developing a
lesson?
Candidates Name:
License:
Date:
Date:
16

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Candidates Name Britany Gage