Multi-Campus Teaching Observation Program Report Form
Instructions: The person who was observed should complete this form. The reflections that you submit here will help us improve the program and will not be shared with others without your permission.
Your name
*
Your e-mail address
*
Your primary campus affiliation (Keck Science Department faculty should choose the college to which they are currently administratively assigned)
*
CGU
CMC
HMC
KGI
PIT
POM
SCR
TCCS
Your department / field group
*
Back
Next
Name of the person who observed you
*
Their primary campus affiliation
CGU
CMC
CUC
HMC
Keck Science Department
KGI
PIT
POM
SCR
TCCS
Their department / field group
Date of the first observation
*
-
Month
-
Day
Year
Date Picker Icon
Date of the second observation (if applicable)
-
Month
-
Day
Year
Date Picker Icon
How many times did you meet in person to debrief about the observations?
Back
Next
What observation form(s)/tool(s) did you use, if any?
None
Double-Entry Narrative Form
Time-Use Observation Form
Student Engagement Observation Form
Group Dynamics Observation Form
Questions Observation Form
Observation Form for Foreign-Language Classes
How helpful was/were those observation forms/tools?
1
2
3
4
5
Very Unhelpful
Very Helpful
How helpful was the feedback that you received?
1
2
3
4
5
Very Unhelpful
Very Helpful
How likely are you to ask for advice about teaching from the person who observed you in the future?
1
2
3
4
5
Very Unlikely
Very Likely
How likely are you to make use of this peer observation program again in the future?
1
2
3
4
5
Very Unlikely
Very Likely
How likely are you to recommend this program to a colleague?
1
2
3
4
5
Very Unlikely
Very Likely
(Optional) Why did you participate in this program?
(Optional) Share with us some of the enhancements that you will make in your teaching as a result of the feedback you received.
(Optional) Do you have any suggestions on how to improve this program?
How did you learn about this program? (Check all that apply.)
CTL email announcement
CTL web site
From a colleague
Back
Next
Do you have a receipt for a meal that you'd like to submit for reimbursement (up to $20 per person, excluding alcoholic beverages)?
*
No, I don't have a receipt to submit for reimbursement.
Yes, and I will send it via campus mail to the Center for Teaching and Learning @ Honnold Library.
Yes, and I want to upload it here.
Meal Receipt Upload
(PDF or image file types allowed. You may take a photo of the receipt and attach that here.)
Submit
Should be Empty: