Subject
Project # District School Teacher Grade Level area Lesson Topic Observer Date
Duration Portion Q.1 Q.2 Q.4 Q.5 Q.6 Q.7 Q.8
Q.9 Q.10 Q.11 Q.12 Q.13 Q.14 Q.15 Q.16
District School Participant ID Code Date Questionnaire Completed Q.1 Q.2
Q.3.a Q.3.b Q.3.c Q.3.d Q.3.e Q.3.f Q.3.g Q.3.h Q.3.i
Q.3.j Q.3.k Q.3.l Q.3.m Q.3.n Q.3.o Q.3.p Q.3..q Q.3.r
Q.3.s Q.3.t Q.3.u Q.3.v Q.3.w Q.3.x Q.4.a Q.4.b Q.4.c
Q.4.d Q.4.e Q.4.f Q.4.g Q.4.h Q.5.a Q.5.b Q.5.c Q.5.d
Q.5.e Q.5.f Q.5.g Q.5.h Q.5.i Q.5.j Q.5.k Q.5.l Q.5.m
Q.5.n Q.5.o Q.6.a Q.6.b Q.6.c Q.6.d Q.6.e Q.6.f Q.7.a
Q.7.b Q.7.c Q.7.d Q.7.e Q.7.f Q.8.a Q.8.b Q.8.c Q.8.d
Data Questionnaire
District School Participant ID code
Completed
Q.1 Q.2 Q.3 Q.4 Q.5 Q.6.a Q.6.b Q.6.c Q.6.d
Q.6.e Q.6.d Q.7.a Q.7.b Q.7.c Q.7.d Q.7.e Q.7.f Q.7.g
Q.7.h Q.8.a Q.8.b Q.8.c Q.8.d Q.8.e Q.8.f Q.8.g Q.8.h
Q.8.i Q.8.j Q.8.k Q.8.l Q.8.m Q.8.n Q.8.o Q.9.a Q.9.b
Q.9.c Q.9.d Q.9.e Q.9.f Q.10.a Q.10.b Q.10.c Q.10.d Q.11.a
Q.11.b Q.11.c Q.11.d Q.11.e Q.11.f Q.11.g Q.11.h Q.11.i Q.11.j
Q.11.k Q.11.l Q.11.m Q.11.n Q.11.o Q.11.p Q.11.q Q.11.r Q.11.s
Q.11.t Q.11.u Q.11.v Q.11.w Q.11.x
Data Questionnaire
District School Participant ID code
Completed
Q.1 Q.2 Q.3 Q.4 Q.5 Q.6.a Q.6.b Q.6.c Q.6.d
Q.6.e Q.6.d Q.7.a Q.7.b Q.7.c Q.7.d Q.7.e Q.7.f Q.7.g
Q.7.h Q.8.a Q.8.b Q.8.c Q.8.d Q.8.e Q.8.f Q.8.g Q.8.h
Q.8.i Q.8.j Q.8.k Q.8.l Q.8.m Q.8.n Q.8.o Q.9.a Q.9.b
Q.9.c Q.9.d Q.9.e Q.9.f Q.10.a Q.10.b Q.10.c Q.10.d Q.11.a
Q.11.b Q.11.c Q.11.d Q.11.e Q.11.f Q.11.g Q.11.h Q.11.i Q.11.j
Q.11.k Q.11.l Q.11.m Q.11.n Q.11.o Q.11.p Q.11.q Q.11.r Q.11.s
Q.11.t Q.11.u Q.11.v Q.11.w Q.11.x
District School Participant ID Code Date Questionnaire Completed Q.1 Q.2
Q.3.a Q.3.b Q.3.c Q.3.d Q.3.e Q.3.f Q.3.g Q.3.h Q.3.i
Q.3.j Q.3.k Q.3.l Q.3.m Q.3.n Q.3.o Q.3.p Q.3..q Q.3.r
Q.3.s Q.3.t Q.3.u Q.3.v Q.3.w Q.3.x Q.4.a Q.4.b Q.4.c
Q.4.d Q.4.e Q.4.f Q.4.g Q.4.h Q.5.a Q.5.b Q.5.c Q.5.d
Q.5.e Q.5.f Q.5.g Q.5.h Q.5.i Q.5.j Q.5.k Q.5.l Q.5.m
Q.5.n Q.5.o Q.6.a Q.6.b Q.6.c Q.6.d Q.6.e Q.6.f Q.7.a
Q.7.b Q.7.c Q.7.d Q.7.e Q.7.f Q.8.a Q.8.b Q.8.c Q.8.d
School District Teacher Grade level Course name Q.1 Q.2 Q.3
Q.4 Q.5 Q.6 Q.7 Q.8. Q.9 Q.10 Q.11 Q.12
Q.13 Q.14 Q.15 Q.16 Q.17 Q.18 Q.19 Q.20 Q.21
Q.22 Q.23 Q.24 Q.25 Q.26 Q.27 Q.28 Q.29 Q.30
Q.31.a Q.31.b Q.31.c Q.31.d Q.31.e Q.31.f Q.31.g Q.31.h Q.31.i
Q.31.j Q.31.k Q.31.l Q.31.m Q.31.n Q.31.o Q.31.p Q.31.q Q.32
School District Teacher Grade level Course name Q.1 Q.2 Q.3 Q.4
Q.5 Q.6 Q.7 Q.8. Q.9 Q.10 Q.11 Q.12 Q.13
Q.14 Q.15 Q.16 Q.17 Q.18 Q.19 Q.20 Q.21 Q.22
Q.23 Q.24 Q.25 Q.26 Q.27 Q.28 Q.29 Q.30 Q.31.a
Q.31.b Q.31.c Q.31.d Q.31.e Q.31.f Q.31.g Q.31.h Q.31.i Q.31.j
Q.31.k Q.31.l Q.31.m Q.31.n Q.31.o Q.31.p Q.31.q Q.32
ID Date Grades Q.1 Q.2 Q.3 Q.4 Q.5 Q.6.a
Q.6.b Q.6.c Q.6.d Q.6.e Q.6.f Q.6.g Q.6.h Q.6.i Q.6.j
Q.6.l Q.6.m Q.7 Q.8 Q.9 Q.10 Q.11 Q.12 Q.13.a
Q.13.b Q.13.c Q.13.d Q.14.a Q.14.b Q.14.c Q.14.d Q.14.e Q.14.f
Q.14.g Q.15.a Q.15.b Q.15.c Q.15.d Q.16.a Q.16.b Q.17.a Q.17.b
Q.17.c Q.17.d Q.17.e Q.18 Q.19.a Q.19.b Q.19.c Q.20.a Q.20.b
Q.20.c Q.20.d Q.20.e Q.20.f Q.21.a Q.21.b Q.21.c Q.21.d Q.21.e
Q.21.f Q.21.g Q.21.h Q.22
Project Code ID Date Q.1 Q.2 Q.3 Q.4 Q.5 Q.6.a
Q.6.b Q.7 Q.8 Q.9 Q.10 Q.11.a Q.11.b Q.11.c Q.11.d
Q.11.e Q.11.f Q.11.g Q.11.h Q.11.i Q.11.j Q.11.k Q.11.l Q.11.m
Q.12.a Q.12.b Q.12.c Q.12.d Q.12.e Q.12.f Q.12.g Q.12.h Q.13.a
Q.13.b
Project Date Location Session Topic Duration
Subject Area Your grade level Q.1 Q.2 Q.3 Q.4.a
Q.4.b Q.4.c Q.4.d Q.4.e Q.4.f Q.4.g Q.4.h Q.4.i Q.4.j
Q.4.k Q.4.l
Particiapnt ID code Date Questioannaire Completed Grades you currently teach Q.1
Q.2 Q.3.a Q.3.b Q.4.a Q.4.b.a Q.4.b.b Q.4.b.c Q.5.a Q.5.b
Q.5.c Q.5.d Q.5.e.a Q.5.e.b Q.5.e.c Q.6.a Q.6.b Q.6.c Q.6.d
Q.7.a Q.7.b Q.7.c Q.8.a Q.8.b Q.8.c Q.8.d Q.8.e Q.8.f
Q.9.a Q.9.b Q.9.c Q.9.d Q.9.e Q.9.f Q.9.g Q.9.h Q.10
Particiapnt ID code Date Questioannaire Completed Grades you currently teach Q.1
Q.2 Q.3.a Q.3.b Q.4.a Q.4.b.a Q.4.b.b Q.4.b.c Q.5.a Q.5.b
Q.5.c Q.5.d Q.5.e.a Q.5.e.b Q.5.e.c Q.6.a Q.6.b Q.6.c Q.6.d
Q.7.a Q.7.b Q.7.c Q.8.a Q.8.b Q.8.c Q.8.d Q.8.e Q.8.f
Q.9.a Q.9.b Q.9.c Q.9.d Q.9.e Q.9.f Q.9.g Q.9.h Q.10
ID Date Grades Q.1 Q.2 Q.3 Q.4 Q.5 Q.6.a
Q.6.b Q.6.c Q.6.d Q.6.e Q.6.f Q.6.g Q.6.h Q.6.i Q.6.j
Q.6.l Q.6.m Q.7 Q.8 Q.9 Q.10 Q.11 Q.12 Q.13.a
Q.13.b Q.13.c Q.13.d Q.14.a Q.14.b Q.14.c Q.14.d Q.14.e Q.14.f
Q.14.g Q.15.a Q.15.b Q.15.c Q.15.d Q.16.a Q.16.b Q.17.a Q.17.b
Q.17.c Q.17.d Q.17.e Q.18 Q.19.a Q.19.b Q.19.c Q.20.a Q.20.b
Q.20.c Q.20.d Q.20.e Q.20.f Q.21.a Q.21.b Q.21.c Q.21.d Q.21.e
Q.21.f Q.21.g Q.21.h Q.22
Observation # Level Lesson Title Date Reviewer Q.I.A Q.I.B Comments
Q.II.A Comments Q.II.B Q.II.C Q.II.D Comments Q.II.E Q.II.F Comments
Q.III Comments Q.IV.A Q.IV.B Comments Q.V.A.Basic Q.V.A.Higher Level Q.V.B
Comments Teacher Level Lesson Title School Date Reviewer Rating Profile
Summary
Observation # Level/Class Lesson Title Date Reviewer With Summer Institute(Y/N) Q.I.A
Comment Comment
Q.I.B Q.I.C Comments Q.II.A s Q.II.B Q.II.C Q.II.D s
Comment Comment
Q.II.E Q.II.F Comments Q.III s Q.IV.A Q.IV.B s Q.V.A.Basic
Q.V.A.Higher Level Q.V.B Comments Teacher Level Lesson Title School Date
Reviewer Rating Profile Summary