Form Doe Ohr 600 006 – Fill Out and Use This PDF

Recent graduates of teacher education programs from colleges/universities in Hawaii shall submit Student Teacher Evaluations

instead of this Confidential Report.

I. INSTRUCTIONS TO APPLICANT:

1.PLEASE SEND THIS CONFIDENTIAL REPORT ON APPLICANT TO THOSE FOR WHOM YOU ARE AUTHORIZING THIS RELEASE OF INFORMATION.

a)Recent graduates of teacher education programs from colleges/universities outside Hawaii shall submit one (1) Confidential Report on Applicant (DOE OHR 600-006) from the college/university faculty who supervised applicant's student teaching.

b)Teachers with one (1) or more years of contracted teaching experience shall submit at least two (2) Confidential Reports on Applicant (DOE OHR 600-006) from the most recent School Principal(s) or Supervisor(s).

2.Print or type in the appropriate information requested below.

3.Provide the evaluator with a stamped envelope with your confidential report request addressed to the Hawaii State Department of

Education, Office of Human Resources, 680 Iwilei Road, Suite 490, Honolulu, Hawaii 96817, Attention: Teacher Recruitment.

Name of Applicant: _____________________________________________________________			Last 4 digits of SSN: ____________
Last	First	M.I.
Address: ________________________________________________		City: _____________________ State: ______ Zip: _______
Applicant Signature: _________________________________________________________			Date: __________________________
			MM/DD/YYYY

Name of Evaluator: _______________________________________________________ Position: ____________________________

Last	First	M.I.
Address: ________________________________________________		City: _____________________ State: ______ Zip: _______

II. INSTRUCTIONS TO EVALUATOR OF CONFIDENTIAL REPORT:

The above-named applicant is seeking a position with the Hawaii State Department of Education. You have been named as a reference who is knowledgeable about his/her professional work. Your appraisal of the applicant is needed. The information you provide will be held in confidence for Department use in the establishment of a selective recruitment pool of prospective employees. We appreciate your candid assessment. Thank you for your early reply.

1. Dates applicant was professionally associated with you: From: ___________________ To: __________________

MM/DD/YYYYMM/DD/YYYY

2.What was the applicant's position? _________________________________________________________________________________

3.What was your official relationship to the applicant? ___________________________________________________________________

4. Would you re-employ the applicant if you had a vacancy?

Yes

No

4a. If "No", please explain: __________________________________________________________________________________________

5. How would you assess the applicant in relation to other employees whom you have supervised?

Upper 10%

Above Average

Average

Below Average

Distribution: Original - Teacher Recruitment

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DOE OHR 600-006

Last Revised: 01/01/2011

Former DOE Form(s): 100a

III. RATING OF PROFESSIONAL COMPETENCIES

Select and enter in the appropriate column the numerical rating that best describes the applicant's ability, knowledge, and/or skills for each category.

Rate all areas, sign, and date this report. Additional comments, if desired, may be submitted with this report.

SCALE: 5-Superior; 4-Above Acceptable Standard; 3-Acceptable; 2-Below Standard; 1-Unacceptable
Competencies of an Effective Teacher:	Rating
1. Focuses on the Learner: Engages students in appropriate experiences that support their development as
independent learners.	______

2.Creates and Maintains a Safe and Positive Learning Environment: Creates a safe and positive learning environment that encourages positive social interaction, civic responsibility, active engagement in learning, and self-

motivation.	______
3. Adapts to Learner Diversity: Provides opportunities that are inclusive and adapted to diverse learners.	______

4.Fosters Effective Communication in the Learning Environment: Enriches communication in the learning

environment.	______
5. Demonstrates Knowledge of Content: Demonstrates competency in content area(s) to develop student knowledge
and performance.	______

6.Designs and Provides Meaningful Learning Experiences: Plans and implements meaningful learning experiences

	for children.	______
7.	Uses Active Student Learning Strategies: Uses a variety of active learning strategies to develop the thinking,
	problem-solving, and learning skills of students.	______
8.	Uses Assessment Strategies: Applies appropriate assessment strategies to evaluate and ensure the continuous
	intellectual, social, physical, and emotional development of the learner.	______
9.	Demonstrates Professionalism: Evaluates the effects of his/her choices and actions and actively seeks opportunities
	to grow professionally.	______
10.	Fosters Parent and School Community Relationships: Establishes and maintains strong working relationships
	with parents and members of the school community to support student learning.	______
OVERALL RATING		______

The applicant is likely to perform satisfactorily according to the above areas of teaching competency based upon his/her demonstrated performance as a student teacher or experienced teacher.

Signature: ________________________________________________________________			Date: ______________________
			MM/DD/YYYY
Official Position: _________________________________________________		School/District: _________________________
Mail the Confidential Report on Applicant to:	Hawaii State Department of Education
	Office of Human Resources
	680 Iwilei Road, Suite 490
	Honolulu, Hawaii 96817
	Attention: Teacher Recruitment

Distribution: Original - Teacher Recruitment

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