☐ First Status Report	Month:	Year:	Panel Contact:
☐ Second Status Report
Career in Teaching Intern Status Report

Intern Name:	School:
Mentor Name:	Job Assignment:
Observation Dates/Times:
Conference Dates:

Effective: Performance meets or exceeds professional expectations Developing: Performance continues to improve in areas indicated. Ineffective: Performance needs improvement in areas indicated.

DOMAIN 1: Planning and Preparation Demonstrates knowledge of important concepts when planning; demonstrates knowledge of students when planning; sets instructional outcomes; Demonstrates knowledge of resources; Designs coherent instruction based on NYS/Common Core Content Standards; Designs coherent instruction for diverse learners; Designs student assessments that correspond to instructional outcomes and that guide planning
☐ Effective	☐ Developing	☐ Ineffective

DOMAIN 2: Classroom Environment Creates an environment of respect and rapport; Establishes a culture for learning; Manages classroom procedures and routines that support student learning; Manages student behavior; Organizes physical space to promote safe learning
☐ Effective	☐ Developing	☐ Ineffective

DOMAIN 3: Instruction Communicates clearly with students; Uses effective questioning and discussion techniques; Engages students in learning (activities/assignments, grouping of students, instructional materials/resources, structure and pacing); Uses Assessment in instruction (monitors student learning, assessment criteria, provides effective feedback, encourages student self-assessment and monitoring of progress); demonstrates flexibility and responsiveness.
☐ Effective	☐ Developing	☐ Ineffective

DOMAIN 4: Professional Responsibilities Reflects on teaching practices to assess the effectiveness of lessons and plans lessons accordingly; Maintains accurate records about student progress; Communicates/engages with families about the instructional program and about student progress; Participates in the school community and district through collaborative relationships with colleagues, participation in school and district projects; Develops and grows professionally by participating in professional learning opportunities to enhance content knowledge and pedagogical skill; Shows professionalism
☐ Effective	☐ Developing	☐ Ineffective

_________________________________________________________	_______________
Mentor signature	Date _________________________________________________________	_______________
Intern signature	Date Signatures indicate that the Mentor has reviewed this report with the Intern. Interns may attach a written response or comments. Please return form under seal to CIT Office, CO-2.