Commonwealth of Pennsylvania DEPARTMENT OF EDUCATION 333 Market St.

, Harrisburg, PA 17126-0333

Pennsylvania Statewide Evaluation Form for Student Professional Knowledge and Practice
Giancatarino ANTHONY MICHAEL

Student/Candidate’s Last Name First Middle Social Security Number

ELEMENTARY ELA, MATHEMATICS,SOCIALSTUDIES,SCIENCE 4TH
Subject(s) Taught Grade Level
This form is to serve as a permanent record of a student teacher/candidate’s professional performance evaluation during a
specific time period, based on specific criteria. This form must be used at least twice during the 12-week (minimum) student
teaching experience.
PERFORMANCE EVALUATION

Directions: Examine all sources of evidence provided by the student teacher/candidate and bear in mind the aspects of
teaching for each of the four categories used in this form. Check the appropriate aspects of student teaching, and indicate the
sources of evidence used to determine the evaluation of the results in each category. Assign an evaluation for each of the four
categories and then assign an overall evaluation of performance. Sign the form and gain the signature of the student teacher.

Category I: Planning and Preparation – Student teacher/candidate demonstrates thorough knowledge of content and pedagogical skills in planning and
preparation. Student teacher makes plans and sets goals based on the content to be taught/learned, knowledge of assigned students, and the instructional
context.
Alignment: 354.33. (1)(i)(A), (B), (C), (G), (H)
Student Teacher/Candidate’s performance appropriately demonstrates:
• Knowledge of content
• Knowledge of pedagogy
• Knowledge of Pennsylvania’s K-12 Academic Standards
• Knowledge of students and how to use this knowledge to impart instruction
• Use of resources, materials, or technology available through the school or district
• Instructional goals that show a recognizable sequence with adaptations for individual student needs
• Assessments of student learning aligned to the instructional goals and adapted as required for student needs
• Use of educational psychological principles/theories in the construction of lesson plans and setting instructional goals

Sources of Evidence (Check all that apply and include dates, types/titles and number)
✔ Lesson/Unit Plans Scripted Plans, Subject lesson Plans ✔ Student Teacher Interviews 9/14,9/21,10/6
✔ Resources/Materials/Technology Whiteboard, ipad, Seesaw, computer ✔ Classroom Observations 9/14,9/21,10/6
✔ Assessment Materials informal assessments,worksheets, packets, Wonders, Eureka ✔ Resource DocumentsCurriculum guides
✔ Information About Students IEP at a glance Other Weekly schedules
(Including IEP’s)
Category Exemplary 3 Points Superior 2 Points Satisfactory 1 Point Unsatisfactory 0 Points

Criteria for Rating The candidate consistently The candidate usually and The candidate sometimes and The candidate rarely or never and
and thoroughly extensively demonstrates indicators adequately demonstrates inappropriately or superficially
demonstrates indicators of of performance. indicators of performance. demonstrates indicators of
performance. performance.
Rating
✔
(Indicate √)
Justification for Evaluation
All of the above criteria have been observed, dialogued, and recorded as evidence during observations based on the criteria found in category I.

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 Commonwealth of Pennsylvania DEPARTMENT OF EDUCATION 333 Market St., Harrisburg, PA 17126-0333

Giancatarino ANTHONY MICHAEL

Student/Candidate’s Last Name First Middle Social Security Number

Category II: Classroom Environment – Student teacher/candidate establishes and maintains a purposeful and equitable environment for learning, in
which students feel safe, valued, and respected, by instituting routines and setting clear expectations for student behavior.
Alignment: 354.33. (1)(i)(E), (B)
Student Teacher/Candidate’s performance appropriately demonstrates:

• Expectations for student achievement with value placed on the quality of student work
• Attention to equitable learning opportunities for students
• Appropriate interactions between teacher and students and among students
• Effective classroom routines and procedures resulting in little or no loss of instructional time
• Clear standards of conduct and effective management of student behavior
• Appropriate attention given to safety in the classroom to the extent that it is under the control of the student teacher
• Ability to establish and maintain rapport with students

Sources of Evidence (Check all that apply and include dates, types/titles, and number)

✔ Classroom Observations9/14,9/21,10/6 ✔ Visual TechnologyWhiteboard,Seesaw, Gimkit,Kahoot,Blookit,PPT,

Informal Observations/Visits N/A
✔ Resources/Materials/Technology/Space seating charts
✔ Student Teacher/Candidate ✔ Other Interactive Websites, portfolio examples
Interviews 9/14,9/21,10/6

Category Exemplary 3 Points Superior 2 Points Satisfactory 1 Point Unsatisfactory 0 Points

Criteria for Rating The candidate consistently The candidate usually and The candidate sometimes and The candidate rarely or never and
and thoroughly extensively demonstrates indicators adequately demonstrates inappropriately or superficially
demonstrates indicators of of performance. indicators of performance. demonstrates indicators of
performance. performance.
Rating
✔
(Indicate √)
Justification for Evaluation
All of the above criteria have been observed, dialogued, and recorded as evidence during observations based on the criteria found in category II.

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 Commonwealth of Pennsylvania DEPARTMENT OF EDUCATION 333 Market St., Harrisburg, PA 17126-0333

Giancatarino ANTHONY MICHAEL

Student/Candidate’s Last Name First Middle Social Security Number

Category III – Instructional Delivery - Student teacher/candidate, through knowledge of content, pedagogy and skill in delivering instruction, engages
students in learning by using a variety of instructional strategies.
Alignment: 354.33. (1)(i)(D),(F),(G)
Student Teacher/candidate’s performance appropriately demonstrates:

• Use of knowledge of content and pedagogical theory through his/her instructional delivery
• Instructional goals reflecting Pennsylvania K-12 standards
• Communication of procedures and clear explanations of content
• Use of instructional goals that show a recognizable sequence, clear student expectations, and adaptations for individual student needs
• Use of questioning and discussion strategies that encourage many students to participate
• Engagement of students in learning and adequate pacing of instruction
• Feedback to students on their learning
• Use of informal and formal assessments to meet learning goals and to monitor student learning
• Flexibility and responsiveness in meeting the learning needs of students
• Integration of disciplines within the educational curriculum

Sources of Evidence (Check all that apply and include dates, types/titles, or number)
✔ Classroom Observations 9/14,9/21,10/6 ✔ Student Assignment Sheets Student Planners
Informal Observations/Visits N/A ✔ Student Work Portfolio worksheets, Seesaw, Social Studies Packet
✔ Assessment Materials informal Assessments ✔ Instructional Resources/Materials/Technology Curriculum guides, ipad
✔ Student Teacher/Candidate ✔ Other In-service, Self-Reflections
Interviews 9/14,9/21,10/6

Category Exemplary 3 Points Superior 2 Points Satisfactory 1 Point Unsatisfactory 0 Points

Criteria for Rating The candidate consistently The candidate usually and The candidate sometimes and The candidate rarely or never and
and thoroughly extensively demonstrates indicators adequately demonstrates inappropriately or superficially
demonstrates indicators of of performance. indicators of performance. demonstrates indicators of
performance. performance.
Rating
✔
(Indicate √)
Justification for Evaluation
All of the above criteria have been observed, dialogued, and recorded as evidence during observations based on the criteria found in category III.

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 Commonwealth of Pennsylvania DEPARTMENT OF EDUCATION 333 Market St., Harrisburg, PA 17126-0333

Giancatarino ANTHONY MICHAEL

Student/Candidate’s Last Name First Middle Social Security Number

Category IV – Professionalism - Student teacher/candidate demonstrates qualities that characterize a professional person in aspects that occur in and
beyond the classroom/building.
Alignment: 354.33. (1)(i)(I),(J)
Student Teacher/Candidate’s performance appropriately demonstrates:

• Knowledge of school and district procedures and regulations related to attendance, punctuality and the like
• Knowledge of school or district requirements for maintaining accurate records and communicating with families
• Knowledge of school and/or district events
• Knowledge of district or college’s professional growth and development opportunities
• Integrity and ethical behavior, professional conduct as stated in Pennsylvania Code of Professional Practice and Conduct for
Educators; and local, state, and federal, laws and regulations
• Effective communication, both oral and written with students, colleagues, paraprofessionals, related service personnel, and
administrators
• Ability to cultivate professional relationships with school colleagues
• Knowledge of Commonwealth requirements for continuing professional development and licensure

Sources of Evidence (Check all that apply and include dates, types/titles, or number)
Student Planner
✔ Classroom Observations 9/14,9/21,10/6 ✔ Student Assignment Sheets
Informal Observations/Visits N/A ✔ Student Work Worksheets, Manipulatives, Portfolio examples
✔ Assessment Materials Informal Assessment for Lessons, AIMSWEB ✔ Instructional Resources/Materials/Technology ipad, computer,whitebd

✔ Student Teacher Interviews 9/14, 9/21, 10/6 ✔ Other AIMSWEB

✔ Written Documentation SPESEA card, Self Reflections, In Service, AIMSWEB

Category Exemplary 3 Points Superior 2 Points Satisfactory 1 Point Unsatisfactory 0 Points

Criteria for Rating The candidate consistently The candidate usually and The candidate sometimes and The candidate rarely or never and
and thoroughly extensively demonstrates indicators adequately demonstrates inappropriately or superficially
demonstrates indicators of of performance. indicators of performance. demonstrates indicators of
performance. performance.
Rating ✔
(Indicate √ )
Justification for Evaluation
All of the above criteria have been observed, dialogued, and recorded as evidence during observations based on the criteria found in category IV.

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 Commonwealth of Pennsylvania DEPARTMENT OF EDUCATION 333 Market St., Harrisburg, PA 17126-0333

Overall Rating
Category Exemplary (Minimum of Superior (Minimum of 8 Points) Satisfactory (Minimum of Unsatisfactory (0 Points)
12 Points) 4 Points)
Criteria for Rating The candidate consistently The candidate usually and The candidate sometimes and The candidate rarely or never and
and thoroughly extensively demonstrates indicators adequately demonstrates inappropriately or superficially
demonstrates indicators of of performance. indicators of performance. demonstrates indicators of
performance. performance.
Rating
✔
(Indicate √ )

Note: This assessment instrument must be used a minimum of two times. A satisfactory rating (1) in each of the 4 categories,
resulting in a minimum total of at least (4) points, must be achieved on the final summative rating to favorably complete this
assessment.

Justification for Overall Rating:

The overall rating is based on observations, evaluations of student teacher performance, conferencing with the student teacher, and feedback from the cooperating teacher.

Giancatarino ANTHONY MICHAEL

Student Teacher/Candidate’s Last Name First Middle Social Security Number

NORTHERN LEBANON/IU 13 EAST HANOVER ELEMENTARY 10/19/2022

District/IU School Interview/Conference Date

2022-2023 FALL
School Year: Term:

Required Signatures: Maryellen Brown

10/19/2022
Supervisor/Evaluator: Date:

Student/Teacher Anthony Giancatarino

10/19/2022
Candidate: Date:
Area of Certification
Certifying Official: ____________________________________________________ Date: ____________________

(Confidential Document)

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Commonwealth of Pennsylvania DEPARTMENT OF EDUCATION 333 Market St., Harrisburg, PA 17126-0333

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