Ppa Form – Fill Out and Use This PDF

The Commonwealth of Massachusetts

Department of Education

350 Main Street, Malden, Massachusetts 02148-5023

Telephone: (781) 338-3000

Preservice Performance Assessment for Practicum or Practicum Equivalent

Professional Standards for Teachers: See 603 CMR 7.08.

Part I –To be completed by the applicant.

Practicum:_____________Practicum Equivalent: ___________

1.Legal Name: (print)________________________________________________________________2. SSN: ______________________________

3.Address: _____________________________________________________________________________________________________________

4.Sponsoring Organization: _____________________________________________________Program & Level: __________________________

5.Practicum/Equivalent Course Number: ______________________________________________Credit Hours: _________________________

Course Title: ________________________________________________________________________________________________________

6.Practicum/Equivalent Site: ______________________________________________________7: Grade Levels of Students: _______________

8.Total number of practicum hours: _________________Number of hours assumed full responsibility in the role: ______________________

9.Other Massachusetts licenses held if any: __________________________________________________________________________________

10.Have any components of the approved program been waived (see Regulations 7.03(1)(b)): Yes _______________No___________________

Part II – To be completed by the Program Supervisor

Name: (print)___________________________________________________________________Position/Title_____________________________

The Applicant completed a practicum/equivalent designed by the Sponsoring organization as partial preparation for the following license: Applicant’s License Field: ___________________________________________________________Grade Level: __________________________

Part III – To be completed by the Supervising Practitioner

Name: (print)_____________________________________________________________________Position: _______________________________

School System: _____________________________________________________License: Initial (# yrs. experience): ______or Professional: _____

Massachusetts License #: ______________________________________________________Field(s): ____________________________________

Part IV – Initial 1, 2, and 3.

1.Initial meeting held at which the Professional Standards and the procedures for evaluation were explained to the Applicant.

Date: ________Applicant: _________________ Program Supervisor: __________________ Supervising Practitioner: __________________

2.Meeting held midway through the practicum at which the Applicant’s progress toward the Professional Standards was discussed.

Date: ________Applicant: __________________ Program Supervisor: _________________ Supervising Practitioner: __________________

3.Final meeting held to complete evaluation and to allow Applicant an opportunity to raise questions and make comments.

Date: ________Applicant: __________________ Program Supervisor: _________________ Supervising Practitioner: __________________

Part V

Candidate has successfully completed the Preservice Performance Assessment (Sections: 7.03(2)(a)(4) & 7.04(2)(b)(4)(b)) Yes: _____No: _____

Program Supervisor (sign): ____________________________________________________________________ Date: _____________________

Supervising Practitioner (sign): _________________________________________________________________ Date: _____________________

Mediator (if necessary: see 7.04(4))(sign): _________________________________________________________ Date: ____________________

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Preservice Performance Assessment for Practicum or Practicum Equivalent

Professional Standards for Teachers: See 603 CMR 7.08

Please use this assessment in conjunction with the Preservice Performance Assessment Guidelines: the rating scale is described on page 4; evaluation questions relating to the standards are pages 5 - 12, and license-specific questions per standard B2c are pages 13-44.

Standard A - Plans Curriculum and Instruction

Indicators	Evidence
1. 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.

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.

Rating Scale: 1=Does Not Meet the Standard; 2=Meets the Standard, 3=Exceeds the Standard; NA=Not Applicable.

Candidate’s Name: _____________________________________________________License: _____________________________

Program Supervisor (initial): ______________________________________________________Date: ______________________

Supervising Practitioner (initial): ___________________________________________________Date: _____________________

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Preservice Performance Assessment for Practicum or Practicum Equivalent

Professional Standards for Teachers: See 603 CMR 7.08

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 and speaking.

c)Uses engaging ways to begin a new unit of study or lesson.

d)Builds on students’ prior knowledge and experience.

2.Communicates high standards and expectations when 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 content-oriented teaching techniques from more teacher-directed 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)Demonstrates an adequate knowledge of and approach to the academic content of lessons. (See license-specific questions in Guidelines, pp. 13-44)

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.

g)Employs appropriate sheltered English or subject matter strategies for English learners.

3.Communicates high standards and expectations when 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.

4.Communicates high standards and expectations when 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.

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 Scale: 1=Does Not Meet the Standard; 2=Meets the Standard, 3=Exceeds the Standard; NA=Not Applicable.

Candidate’s Name: _____________________________________________________License: __________________

Program Supervisor (initial): ______________________________________________________Date: __________

Supervising Practitioner (initial): ___________________________________________________Date: __________

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Preservice Performance Assessment for Practicum or Practicum Equivalent

Professional Standards for Teachers: See 603 CMR 7.08

Standard C – Manages Classroom Climate and Operation

Indicators

Evidence

1.Creates an environment that is conducive to learning.

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.

Rating Scale: 1=Does Not Meet the Standard; 2=Meets the Standard, 3=Exceeds the Standard; NA=Not Applicable.

	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.

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.

Rating Scale: 1=Does Not Meet the Standard; 2=Meets the Standard, 3=Exceeds the Standard; NA=Not Applicable.

Candidate’s Name: _____________________________________________________License: __________________

Program Supervisor (initial): ______________________________________________________Date: ___________

Supervising Practitioner (initial): ___________________________________________________Date: __________

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Preservice Performance Assessment for Practicum or Practicum Equivalent

Professional Standards for Teachers: See 603 CMR 7.08

Standard E – Meets Professional Responsibilities

Indicators

Evidence

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. Works actively to involve parents in their child’s academic activities and performance, and communicates clearly with them.

6.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.

7.Understands legal and ethical issues as they apply to responsible and acceptable use of the Internet and other resources.

Rating Scale: 1=Does Not Meet the Standard; 2=Meets the Standard, 3=Exceeds the Standard; NA=Not Applicable.

Candidate’s Name: _____________________________________________________License: __________________

Program Supervisor (initial): _____________________________________________________Date: ____________

Supervising Practitioner (initial): __________________________________________________Date: ___________

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Preservice Performance Assessment for Practicum or Practicum Equivalent

Professional Standards for Teachers: See 603 CMR 7.08

Summary Decision for Preservice Performance Assessment

Teacher candidate’s Preservice Performance Assessment in the practicum or practicum equivalent meets the Professional Standards for Teachers: Yes ________ or No ________.

Candidate (sign): _______________________________________________________License: ________________

Program Supervisor (sign): _______________________________________________________Date: __________

Supervising Practitioner (sign): ____________________________________________________Date: __________

Standard

Rating (from pp. 2-5)

(a)Plans Curriculum

(b)Delivers Effective Instruction

(c)Manages Classroom Climate

(d)Promotes Equity

(e)Meets Professional Responsibilities

Rating Scale: 1=Does Not Meet the Standard; 2=Meets the Standard, 3=Exceeds the Standard; NA=Not Applicable.

Summary Comments (integrated assessment of performance):

The sponsoring organization should maintain this assessment record as part of its candidate’s permanent file. Copies do not have to be sent to the Department of Education.

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