Massachusetts Department of
Elementary and Secondary Education
15 aso Sra zen, Nareachuate OB S06 ee,
Pre-service Performance Assessment Form for Teachers
{603 CMR 7.08 Profesional Standards for Tashert
Par —Tobe completed by the candidate Clpacticum ~ Srracticum eqivlent
is ame: Karin [iat name: apie
Steet Aderest: 2058 Warr ve W.
Giy/Town: Usage [states wa Tae ois
Program & vel Ki?
Pracicum/Equialent Cowie Number PAPAL [eaitroars WA
Practicum Course Tie: WA
Praieum/Equbvalent Ste: Naik Pub hook Grade aval af Sudan: £7
“Total Number of Padi Hows: WA Toba 6 Rout assumed ul espnsibiiy inthe Ola WA
‘ther assacusets ens el fa
Have any components of the apooved program been wahed? 603 Ca 7oR(06) [ves Ba Wo
Part 2- To be competed bythe Progam Supervisor
Name: Anne Marie Merit
‘The Candidate completed Pradicm Practica Equvlent designed bythe Sponsoring Grganitalion os par preparation or
the folowing ese:
Candies cen Feld: Instructional Technology Sait Grade Level 32
To thebestof my nowledge [perth Supervising PrecttionersPrinpa/Evaluator) the Superving Praciioner has received =
summative evluationratigofproflant or higher in his/her most erent evasion GQ ves L] No
Pant3-To be completed bythe Supervising Practitioner
[[name: marie norton [ betion: iatroctanal Technology Spada
School Dive: Nate Pu chooks
‘cease: — [Jini Derotssional Wot year of experience under Reese: Byes
MEPIO:SO3S3395 or Leese cense Fells): Instructional Technology Seca
Parental 12,3,
1 intl meeting held at which the PoTesonal Standards andthe procedure Tor evaluaipn ware axgained tc We anaes,
Date: 10/9/2034 Candidate: (OO rogram Supervisor: Supervising acinar. PJ
2 Meeting held midway trough the practicum a which the Candas progres toward the Professional tadords was
ute 21972018 cantdate: Program Superior supervising actione)
Frat mesg BOTs Gn alain andi he Gas oppor ae Gesont a mae omeers
ome sans canine — poganswenior AY susngncsioned A