Sei Candidate Instruction Evaluation Form
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1
2SEI CANDIDATE INSTRUCTION EVALUATION FORM
(Submit with your application & Instructor Objective Completion Record for initial recognition or renewal)
SEI Candidate’s Printed Name: __________________________ Signature: ________________________________
DOH Course
Instructor Objective Number
Approval Number: ____________ OR Lecture/Skill Lab Topic: _________________________ Date: ____________
(If reevaluation, indicate N/A)
SEI-E ’s Printed Name: _________________________________ Signature: ________________________________
INSTRUCTIONS: Please complete this form for each lesson Instructor Objective performed by the SEI candidate.
Evaluate both content of presentation and instructor knowledge. Circle the appropriate rating: N/A) See Note Below
1) Needs improvement 2) Satisfactory 3) Good
4) Excellent. * Identifies critical elements. If a number 1 is circled
on a critical element, an Instructor Objective Quality Improvement Record must be completed.
NOTE: Circling N/A is only appropriate for components where N/A appears in the “Not Applicable” column).
Not
Needs
THE INSTRUCTOR:
Applicable
improvement
Satisfactory
Good
Excellent
*
1
2
3
4
1.
Clearly stated the objectives for the lecture/practical lab.
*
1
2
3
4
2.
Met the stated objectives for the lecture/practical lab.
*
1
2
3
4
3.
Summarized key points at end of lecture/practical lab.
*
1
2
3
4
4.
Was knowledgeable in the lecture topic/practical skill(s).
*
1
2
3
4
5.
Clearly presented material and was easily understood.
*
1
2
3
4
6.
Was prepared and made good use of class time.
7. Used appropriate and easy to follow audio-visual aids.
N/A
1
2
3
4
8. Taught lesson material in a logical progression.
N/A
1
2
3
4
9. Made lecture/practical skill lab interesting.
1
2
3
4
10. Presented information in various ways to accommodate
N/A
1
2
3
4
information retention; i.e., charts, visuals?
11. Correlated classroom instruction to actual field
1
2
3
4
application.
12. Was positive/enthusiastic about class/practical labs?
1
2
3
4
13. Controlled distractions appropriately/adequately.
N/A
1
2
3
4
14. Encouraged students to interact with each other.
N/A
1
2
3
4
15. Projected professional demeanor.
1
2
3
4
16. Appropriate personal appearance.
1
2
3
4
17. Projected voice clearly.
1
2
3
4
18. Maintained composure
1
2
3
4
19. Gestured appropriately.
1
2
3
4
*
1
2
3
4
20.
Encouraged class participation/questions.
Revised 10/02
Appendix B: - Page 3
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