Lead Teacher-Mentor observing and completing this reflection: __________

Lead Teacher-Mentor being observed in conference: __________

Intern or Professional Support Teacher being observed in conference: __________

Date: __________	Time:	__________	Place of Observation: ___________

Activities Observed (check as many as apply):

☐ Mentor-Intern pre-conference	☐ Mentor observing lesson

☐ Mentor-Intern post conference	☐ Mentor-Administrator

☐ Observer conference separately with intern	☐ Observer conference with building administrator

☐ Other (describe):

Brief Reflection:

What was effective about the Mentor-Intern conference you observed?

What strategies/questions/approaches did you observe that you might consider using in your own mentoring work?

Any additional comments:

Observer’s Signature: ___________________________________	Date: ______________

Signature of Mentor being Observed: ________________________________	Date: ______________

Did the two mentors have an opportunity to discuss this observation/reflection? ☐Yes	☐No

If “Yes,” please note any additional insights from that discussion:

Lead Teacher may attach a written response to this form. Please send copy of signed form to the CIT Office.