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We would appreciate your input regarding the services provided by the Special Education Support Staff member assigned to your campus. Please complete the following questions about your support staff no later than April 30th:
Your Name:
Campus Name
Position of staff for whom you are providing feedback
Please select the position for whom you are completing this evaluation:
Diagnostician
LSSP (Licensed Specialist in School Psychologist)
Dual Role Diag/LSSP
SLP (Speech Language Pathologist
OT (Occupational Therapist)
PT (Physical Therapist)
APE (Adaptive PE)
Name of Person for whom you are providing feedback:
Please type the name of evaluation staff for whom you are providing feedback:
Communicates effectively with school staff
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Communicates effectively with parents
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Makes appropriate recommendations in Staffings/ ARD Meetings
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Is well prepared for Staffings/ ARD Meetings
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Reports to school, meetings and assigned duties on time and maintains an acceptable attendence rate
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Complies with local campus/district procedures
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Exhibits poise and self-control
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Demonstrates effective listening skills
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Functions as a cooperative, positive team member
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Is supportive of the RTI (Response to Intervention) process
5 = Clearly Outstanding
4= Exceeding Expectations
3= Satisfactory
2= Below Expectations
1= Unsatisfactory
Additional Comments:
Please share any additional comments:

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