Teacher Self Assessment Form A Page 3

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Domain I: Planning
Indicators
Standard 3
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
Selects instructional goals
that incorporate higher level
include instructional goals that
inconsistently include
include instructional goals that
consistently include
learning for all students.
incorporate higher level
instructional goals that
incorporate higher level
instructional goals that
learning for students.
incorporate higher level
learning for students.
incorporate higher level
learning for students.
learning for students and are
connected to previous units
and content.
The teacher’s plans do not
The teacher’s plans include
The teacher’s plans frequently
The teacher’s plans
Selects instructional goals
that incorporate higher level
include instructional goals
instructional goals, but goals
include instructional goals
consistently include
learning for all students.
appropriate for students.
are not appropriate for all
appropriate for students, but
instructional goals that are
students.
goals are not specific,
specific, measurable, time
measurable, or time bound.
bound, and appropriate for
students.
The teacher’s plans do not
The teacher’s plans
The teacher’s plans frequently
The teacher’s plans
Selects instructional goals
that incorporate higher level
demonstrate that the teacher
inconsistently demonstrate
demonstrate that the teacher
consistently demonstrate that
considers students’ individual
considers students’ individual
learning for all students.
that the teacher considers
the teacher analyzes multiple
students’ individual skill
skill levels when selecting
skill levels when selecting
and appropriate data sources²
to determine students’ skill
instructional goals and
levels when selecting
instructional goals and
strategies.
instructional goals and
strategies.
levels and considers those
strategies.
levels when selecting
instructional goals and
strategies.
The teacher’s plans do not
The teacher’s plans include
The teacher’s plans frequently
The teacher’s plans
Selects instructional goals
that incorporate higher level
include instructional goals that
instructional goals; however,
include instructional goals that
consistently include
learning for all students.
align with state content
the goals only partially align
fully align with state content
instructional goals that fully
standards or, when applicable,
with state content standards
standards or, when applicable,
align with state content
the CCSS.
or, when applicable, the
the CCSS but do not
standards or the Common
CCSS.
culminate in a performance
Core State Standards (CCSS)
task(s).
and culminate in a
performance task(s).
²(e.g., formal and informal assessments, pre-assessments, classroom questions, and behavior)
3
August 2013

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