Instructional Staff Self Reflection Form

Name

First NameLast Name
Date

MonthDayYear
Date
Domain 1: Planning and Preparation
Demonstrating Knowledge of Content and Pedagogy

Not Yet StartedPartially StartedPartially EstablishedWell Established
Demonstrating Knowledge of Students

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Setting Instructional Outcomes

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Demonstrating Knowledge of Resources

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Designing Coherent Instruction

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Designing Student Assessments

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Strengths & Evidence in Domain 1:
Areas for Growth in Domain 1:
Domain 2: The Classroom Environment
Creating an Environment of Respect and Rapport

Not Yet StartedPartially StartedSomewhat EstablishedWell Estabiished
Establishing a Culture of Learning

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Managing Classroom Procedures

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Managing Student Behavior

Not Yet StartedPartially startedSomewhat EstablishedWell Established
Organizing Physical Space

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Strengths & Evidence in Domain 2:
Areas for Growth in Domain 2:
Domain 3: Instruction
Communicating with Students

Not Yet StartedPartially StartedSomewhat EstablishedWell Estabiished
Using Questioning and Discussion Techniques

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Engaging Students in Learning

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Using Assessment in Instruction

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Demonstrating Flexibility and Responsiveness

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Strengths & Evidence in Domain 3:
Areas for Growth in Domain 3 :
Domain 4: Professional Responsibilities
omeReflecting on Teaching

Not Yet StartedPartially StartedSomewhat EstablishedWell Estabiished
Maintaining Accurate Records

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Communicating with Families

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Participating in a Professional Community

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Growing and Developing Professionally

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Showing Professionalism

Not Yet StartedPartially StartedSomewhat EstablishedWell Established
Strengths and Evidence in Domain 4:
Areas for Growth in Domain 4:
Professional Goal:
What is one goal you would like to focus on?
How can I Support you?
What support or resources do you need from school leadership?
Should be Empty:

Domain 1: Planning and Preparation

Domain 2: The Classroom Environment

Domain 3: Instruction

Domain 4: Professional Responsibilities

Professional Goal:

How can I Support you?