Mark Bailey - 5th Year MAT Materials

Pacific University
Work Sample Assessment Sheet

Name	_________________________________________________	Subject Area	_______________
Work Sample Title	_________________________________________________	Grade Level	_______________

Your work sample should be word processed, and should include all components listed below. Refer to narrative descriptions in the Work Sample Scoring Guide for details. Evaluated components are scored as 5, 4, 3, 2, 1 according to performance levels in the Scoring Guide.

	Performance Level
A. Rationale	.
B. Benchmarks	.met / not met
C. Learning Goals	.
D. Key Points	.
E. Content Relationships	.
F. Weekly Plan	.
G. Assessment Plan
• Formative and Summative Plan	.
• Performance Task and Scoring Guide	.
• Pre-Instruction Assessment and Scoring Guide	.
• Post-Instruction Assessment and Scoring Guide	.
H. Lesson Plans
• Learning Objectives	.
• Instructional Skills	.
• Learning Strategies	.
• Instruction and Lesson Sequence	.
• Assessment of Learning	.
• Reflection on Lesson	.
I. Accommodating Individual Differences	.
J. Promoting Cultural Competence	.
K. Cross-Curricular Integration	.
L. Applications of Technology and Multimedia (Use and projected use)	.
M. Communication and Feedback (Efforts and examples)	.
N. Summary and Interpretation of Assessment Data for the Class as a Whole	.
O. Interpretation of Assessment Data for Selected Students	.
P. Evaluation of Planning and Teaching	.
Q. Resources	met / not met.
R. Overall Presentation	.
Comments . . . . .	.
Work Sample Total Performance Score ____________	Pass/ No Pass
Score must be at least 80% of the total with all individual sections scored 3 or above and "met"

_______________________________________________	________
University Supervisor	Date

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Page last updated on Tuesday, January 6, 2009