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2CNameStudent ID # 3Course EDU207 C SectionCourse Instructor@riosalado.eduALL PAGES MUST BE ATTACHED –Hours must add up to the total required in eachsection for this course.Incomplete documents or those with errors will be returned to the student. Failure tocomplete this form correctly may result in failure of the course or a delay in posting a finalgrade.Field Experience Verification and Mentor Teacher Evaluation FormRio Salado College has adopted a Practitioner’s Model for the preparation of candidates seekingto become certified teachers. The Practitioner’s Model is where candidates receive hands-onexperience in the classroom learning from master teachers throughout the teacher preparationcoursework.Every candidate must complete the field experience process in some form; modifications are made forRio Salado students who are employed in a classroom.The mentor teacher and/or administrator: Must verify the dates and times that the Rio Salado candidate was present in the classroomby initialing the boxes on the Field Experience Verification Form. Complete the Performance-Based Field Experience Mentor Teacher Assessment Tool. Provide a signature at the end of this document. Return this form to the address below immediately following completion of the fieldexperience as a final course grade will not be posted until this form has been received.Rio Salado Student Field Experience RequirementsCandidates must:1. Only observe the same mentor teacher for two course field experiences.2. Provide the mentor with the Mentor Teacher Responsibility information as provided in thecourse.3. Complete the required information at the top of this page.4. Complete and document the minimum required hours in each section. Hours, dates, andtimes must not be duplicated. A separate form must be submitted for each course forwhich you are enrolled. All pages of this document must be returned.4. Make a copy of this form prior to submitting it to your mentor teacher. In the event of aform being lost, you will still have your hours and dates available for re-verification.5. Provide your mentor teacher and/or administrator a verification form with section Acompleted. Your mentor teacher and/or administrator will complete section B.Delivery methods:1. Provide a stamped envelope with the followingaddress:Rio Salado CollegeATTN: Your Instructor’s NameP.O. Box 63310, Phoenix, AZ 85082-3310Your Mentor Teacher or Administrator will return the form in the envelope you provide3/14/2012
2C2. Mentor teachers may scan a final copy of the documentation directly to the emaillisted at the top of this document.Forms will not be accepted directly from Rio Salado pre-service teacher candidateField Experience Verification Form:teacher/administrator for verification.To be completed by student prior to submitting to mentorCounting this course, how many classes with a field experience requirement are you currently enrolled in?How many field experience classes have you completed and been graded out of?Complete the following:Mentor Teacher/AdministratorInitialsObservation (5 hours)Start Time:End Time:Total Time:Total:3/14/2012Description of Activity Observed/participated:
2CComplete the following:Tutoring/Participation (11 hours)Date:Start Time:End Time:Total Time: Description of Activity and number ofstudents worked with if tutoring:Total:3/14/2012Mentor teacher/AdministratorInitials
2CComplete the following:Teaching (4 hours)Date:3/14/2012Start Time:End Time:Mentor teacher/AdministratorInitialsTotal Time: Description of Activity:
2CPerformance-Based Field Experience Mentor Teacher Assessment Tool:completed by the mentor teacher.To beMentor Teacher: Upon completion of the form please have a discussion with the Rio Salado preservice teacher candidate about your evaluation of their work then submit the final paperwork to theinstructor’s name listed on the first page of this form example: adjunct.name@riosalado.edu; a finalcourse grade will not be posted until this form has been received. If you are uncomfortablesharing your evaluation with Rio Salado’s pre-service teacher candidate and would prefer thatRio’s teacher education office meet with the student, please contact our office.Directions:Each Rio Salado candidate must be evaluated on the evaluation form for each fieldexperience. The evaluation must be completed and signed by the mentor teacher thatobserved the Rio Salado pre-service teacher candidate’s work in the classroom. Anoverall rating is achieved by compiling the student’s scores in each of the sub-areasassessed. And then dividing by the total number of questions.Any rating of 2 Beginner and 1 Unsuitable provide an explanation in the“Comments” area. Your comments will assist Rio Salado College in creatingindividualized intervention/remediation plans for the pre-service teacher candidate.Any candidate scoring in an overall category of Unsuitable will be contacted bythe college and referred to support services for information on next steps withinthe coursework and program.General QuestionsSub Group A Total3/14/2012BeginnerUnsuitable3. Although the time spent withRio Salado’s Teacher Candidate’swas limited, please rate their oralcommunication skills. [InTASC3(f); CEC 9]4. Although the time spent withRio Salado’s Teacher Candidate’swas limited, please rate their levelof social adjustment, from yourperspective. [InTASC (3); CEC 5]CommentsExperienced1. The Rio Salado TeacherCandidate was respectfulof students in the classroom.[InTASC 9; CEC 2, 9]2. The Rio Salado TeacherCandidate was appropriately andprofessionally dressed.RatingsSkilledCriteria4321432143214321
2CClassroom Observation TimeBeginnerUnsuitableCommentsExperienced5. The Rio Salado TeacherCandidate remained engaged andinterested in the classroomactivities during his/herobservation time. [CEC 10]6. The Rio Salado TeacherCandidate followed the lead of thementor teacher and interacted withstudents when it was appropriateor remained unobtrusive andobserved, when appropriate. [CEC10]RatingsSkilledCriteria43214321Sub Group B TotalTutoring TimeSub Group C d7. The Rio Salado TeacherCandidate consulted with meabout which students to tutor andthe necessary content to cover inthe tutoring session. [InTASC7(o), 9(a), 10 (b); CEC 10]8. The Rio Salado TeacherCandidate worked well withstudents. [InTASC 1(h,i,j); 2(l,m,n); 3 (e,q); 4 (b,l,r); 6 (s);CEC 5]RatingsSkilledCriteria43214321
2CClassroom Teaching TimePerformanceSub group D d9. The Rio Salado Studentengages learners in learningexperiences in the discipline(s)that encourage learners tounderstand, question, and analyzeideas from diverse perspectives sothat they master the content.InTASC 4(b)10. The Rio Salado Studentstimulates learner reflection onprior content knowledge, linksnew concepts to familiarconcepts, and makes connectionsto learners’ experiences. InTASC4(d)11. The Rio Salado Studentrecognizes learner misconceptionsin a discipline that interfere withlearning, and creates experiencesto build accurate conceptualunderstanding. InTASC 4(e)12. The Rio Salado Student usessupplementary resources andtechnologies effectively to ensureaccessibility and relevance for alllearners. InTASC 4(g)13. The Rio Salado Studentcreates opportunities for studentsto learn, practice, and masteracademic language in theircontent. 1
14. The Rio Salado Studentrealizes that content knowledge isnot a fixed body of facts but iscomplex, culturally situated, andever evolving. S/he keeps abreastof new ideas and understandingsin the field. InTASC 4(o)15. The Rio Salado Studentrecognizes the potential of bias inhis/her representation of thediscipline and seeks toappropriately address problems ofbias. InTASC 4(q)16. The Rio Salado Student iscommitted to work toward eachlearner’s mastery of disciplinarycontent and skills. InTASC 4(r)RatingsSkilledCriteria432143214321Sub Group E Total/16* Average Sub Group ASub Group BSub Group CSub Group DSub Group EGrand Total/16 Average score*The overall score should only be divided by the actual number of prompts thatwere scored. If items were not observed or not required, the score would bedivided by a different number.3/14/2012
2COverall Field Experience Rating (See calculation/averaging directions above): Skilled(3.5 and Higher) Experienced(3.0-3.49) Beginner(2.99-2.0) Unsuitable(1.99 and lower)3/14/2012Reflects only pre-service teacher candidates who possess and demonstrate a trulyexemplary understanding, mastery, and consistent integration of relevant concepts andprofessional teaching skills while completing their field experience requirements. Theseindividuals regularly engage in activities that intentionally focus on student success.Reflects a pre-service teacher candidate with the skills and knowledge of a student whohas successfully completed some teacher education course work. Such candidates havemastered important concepts and demonstrated the ability to apply these to concreteproblems, but in contexts of limited situations.Reflects a pre-service teacher candidate who is a new student to the field of education.Such candidates are engaged in their baccalaureate or post-baccalaureate course work inteacher education course work. However, the Beginning Candidate possesses only alimited or superficial knowledge and awareness of concepts associated with educationalconcepts. This is the minimum rating in order for a student to be successful in a fieldexperience.Reflects a pre-service teacher candidate, regardless of program level, who is not engagedin the educational process; including but not limited to unprofessional dress,inappropriate behavior with students, and general non-concern for the well-being ofclassroom students and education staff.
2CPlease indicate the strengths of the Pre-Service Teacher Candidate:Do you give permission for Rio Salado to share your evaluation information with the student?YesNoMentor Teacher Payment will be processed upon receipt of this form. To formalize the paymentprocess, please visit our website es/mentorteacher-payment.aspxInformation not received by June 30th of any year will result in forfeiture of stipend. Payment is notapplicable if student is teaching on an emergency certificate, long-term substitute assignment, TeacherIn-Residence or completing only observation hours in your classroom.Mentor Teacher – (Observing and/or tutoring in a certified mentors classroom.)District :Teacher :Signature :SchoolSubject Area:Grade Level:Administrator- The administrator signature is ONLY necessary for Rio Salado pre-servicecandidates using their own classroom and observing a certified teacher(s) outside of theirclassroom.District :Administrator (print name):Signature :SchoolGrade Level:Position:Date:Student is:classroom)3/14/2012Regular CertifiedIntern/Emergency CertifiedLong-term Sub(4 weeks in same
Rio Salado students who are employed in a classroom. The mentor teacher and/or administrator: Must verify the dates and times that the Rio Salado candidate was present in the classroom by initialing the boxes on the Field Experience Verification Form. Complete the P erfo man c-Based Field Experi n Mentor T a h A s ssm nt Tool.
