Clear Form
IPEGS D
C
S
OCUMENTATION
OVER
HEET
Professional’s Name: __________________________________ Employee Number: _____________
Assessor’s Name: ____________________________________ School Year____________________
Directions: Professionals will place required items in sequential order behind this cover sheet and staple
in the upper left hand corner. Submit the packet to your assessor at least 35 calendar days prior to the last
day of the school year for professionals. Assessors will review the submission and make evaluative notes
in the appropriate sections of this cover sheet.
Check if
Required Item
submitted
Professional Development/Professional Growth Experiences
Summarize the Professional Development/growth experiences that contributed to the improvements made in
instructional delivery and student achievement – Provide evidence of the successful completion of
professional development/growth experiences. Evidence may include, but is not limited to, professional
development records, college transcripts, or meeting/conference agendas. Additionally, professionals may
provide evidence of other professional growth experiences (e.g., records of participation in Lesson Study,
Book Study, or professional educational organizations.
Assessor Evaluative Notes
Communication
Provide evidence of how the professional communicates with stakeholders (e.g., families, students, staff, and other
members of the learning community). Evidence may include communication logs, meeting notes, or samples of emails.
Assessor Evaluative Notes
Reviewed by:
Assessor’s Signature: _________________________________________________ Date: ________________
FM-7407 Rev. (05-16)