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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

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