Dutchess BOCES

End-of-Year Summary Form

(For both Formal Observation and Project Options)

Teacher:	Date:
Administrator:	Building/Grade Level:

Teacher’s Status (check one): Probationary: Year 1 Year 2 Year 3 or Tenured:

Assessment Option Selected: Please describe the option selected. To be completed by teacher.
Reflective Summary: Please describe your progress and outcomes and refer specifically to the targeted criteria/domain, including their descriptive elements. Attach additional pages if necessary. Indicate items that reflect your area of strength. To be completed by teacher.
Administrator’s Comments: Please provide feedback for instructional improvement and identify professional development targets for the following year.
[Please Note: Text boxes above will automatically lengthen as needed.]

Administrator and teacher conducted a post-evaluation conference on the above items.

____________________________ ____________________________

Staff Member’s Signature	Administrator’s Signature

_________________	_________________

Date	Date

Distribution: Personnel File

Supervisor

Employee

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Appendix E.

Domain IV IV

rouse jeffery

2010-09-20

www.dcboces.org