Teacher Self Assessment Form A
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22Mississippi Statewide Teacher Appraisal Rubric
Teacher Self-Assessment Form A
Teacher: _________________________
School: ______________________________
School District: ___________________
Grade/Subject:________________________
Date: _____________________
Directions: Reflect on your teaching practice and determine the level of performance that best describes your own assessment for each indicator of the rubric.
Support your judgment by circling or highlighting appropriate words/phrases. Complete Form B based on your self-assessment.
Domain I: Planning
Indicators
Standard 1
Performance Level 1
Performance Level 2
Performance Level 3
Performance Level 4
The teacher’s plans do not
The teacher’s plans
The teacher’s plans frequently
The teacher’s plans
Plans lessons that
demonstrate knowledge of
include the necessary content
inconsistently include the
include the necessary content
consistently include the
and do not connect content
necessary content and/or do
and connect content across
necessary content and connect
content and pedagogy.
across disciplines.
not connect content across
disciplines; however,
content across disciplines;
disciplines.
connections are not
connections are consistently
consistently clear, meaningful,
clear, meaningful, and
or relevant to students’ lives.
relevant to students’ lives.
The teacher’s plans do not
The teacher’s plans
The teacher’s plans frequently
The teacher’s plans
Plans lessons that
demonstrate appropriate
demonstrate inconsistent
demonstrate appropriate
consistently demonstrate
demonstrate knowledge of
sequencing of learning
sequencing of learning
sequencing of learning
appropriate sequencing of
content and pedagogy.
experiences or provide ways
experiences or provide only
experiences and provide
learning experiences and
to demonstrate knowledge and
limited ways to demonstrate
several ways to demonstrate
provide multiple and varied
skill.
knowledge and skills.
knowledge and skill.
ways to demonstrate
knowledge and skill.
The teacher’s plans do not
The teacher’s plans
The teacher’s plans frequently
The teacher’s plans
Plans lessons that
demonstrate knowledge of
demonstrate appropriate
inconsistently demonstrate
demonstrate appropriate
consistently demonstrate
content and pedagogy.
choice of strategies,
appropriate choice of
choice of strategies,
collaboration with specialized
accommodations, resources,
strategies, accommodations,
accommodations, resources,
professionals¹ in making the
and materials to differentiate
resources, and materials to
and materials to differentiate
appropriate choice of
instruction for individuals and
differentiate instruction for
instruction for individuals and
strategies, accommodations,
groups of learners; do not
individuals and groups of
groups of learners but do not
resources, and materials to
demonstrate collaboration
learners; do not demonstrate
demonstrate collaboration
differentiate instruction for
with specialized
collaboration with specialized
with specialized professionals.
individuals and groups of
professionals.¹
professionals.
learners.
¹ (e.g., special educators, related service providers, language learning specialists, librarians, media specialists)
1
August 2013
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