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Teacher Evaluation Template

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					                                                                      CONFIDENTIAL
                      GEORGIA TEACHER EVALUATION PROGRAM: ANNUAL EVALUATION SUMMARY REPORT

                                                                               DeKalb County School System

Teacher’s Name                                                                            System                                          School

    System               School     Last 4 Digits       Last 4 Digits                          Date
  State Code           State Code   Teacher SSN      Primary Evaluator           MO            DAY             YR              Evaluation Summary
                                                            SSN
                                                                                                                        Georgia Teacher    Georgia Teacher        Overall
  6       4      4                                                                                                        Observation        Duties and          Evaluation
      Teacher’s Race / Ethnicity    Teacher’s Sex               Current Year Status (check only one)                      Instrument       Responsibilities
                                                    For teachers with fewer For teachers with For teachers with 3 or       (GTOI)             Instrument
   American Indian, Alaskan                         than 3 years experience 3 or more years more years experience                             (GTDRI)
Native                                                                      experience new to
                                                                            system
      Asian, Pacific Islander

      Hispanic                      Male               Standard Year 1                             Formative Year 1
                                                                                                                       Satisfactory       Satisfactory        Satisfactory

      Black, Non-Hispanic           Female             Standard Year 2          Standard           Formative Year 2
                                                                                                                       Unsatisfactory Unsatisfactory Unsatisfactory

      Multi-Racial                                     Standard Year 3                             Standard
                                                                                                                       Not Applicable
                                                                                                                       (Formative Only)
      White, Non-Hispanic

                            GEORGIA TEACHER OBSERVATION INSTRUMENT                                                               MARK ONLY AREAS FOR
                                                                                                                                    REQUIRED PDP
                                      SUMMARY COMMENTS
                                                                                                                        A. Instructional Level

                                                                                                                        B. Content Development
                                                                                                                            1. Teacher - Focused

                                                                                                                            2. Student - Focused

                                                                                                                        C. Building for Transfer

                                                                                                                        A. Promoting Engagement

                                                                                                                        B. Monitoring Progress

                                                                                                                        C. Responding to Student
                                                                                                                        Performance
                                                                                                                        D. Supporting Students

                                                                                                                        A. Use of Time

                                                                                                                        B. Physical Setting

                                                                                                                        C. Appropriate Behavior

                 GEORGIA TEACHER DUTIES AND RESPONSIBILITIES INSTRUMENT                                                           IDENTIFY GTDRI AREAS
                                                                                                                                    FOR REQUIRED PDP
                                  SUMMARY COMMENTS                                                                         (REFER TO INSTRUMENT FOR CODES)




(Signatures)      PRIMARY EVALUATOR __________________________________________                 DATE ___________________                      Sign and return copy to
                                                                                                                                             principal’s office. Signature
                                                                                                                                             acknowledges receipt of
                  TEACHER _____________________________________________________                DATE ___________________
                                                                                                                                             form, not necessarily
                                                                                                                                             concurrence. Written
                  PRINCIPAL ____________________________________________________               DATE ___________________
                                                                                                                                             comments may be provided
Teacher’s Comments ___________________________________________________________________________________                                       and/or attached.
 ____________________________________________________________________________________________________                                        Initial and date here if
                                                                                                                                             comments are attached.
 ____________________________________________________________________________________________________
                                                                                                                                             _______________________

				
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