Self-Assessment Form

EducatorName/Title:

Janice Caron/4th Grade Teacher

Primary EvaluatorName/Title:

Adam Renda/Principal

Supervising Evaluator, if anyName/Title/Role in evaluation:

School(s):

Crocker Elementary School

Part 1: Analysis of Student Learning, Growth, and Achievement

Briefly summarize areas of strength and high-priority concerns for students under your responsibility
for the upcoming school year. Cite evidence such as results from available assessments. This form
should be individually submitted by educator, but Part 1 can also be used by individuals and/or teams
who jointly review and analyze student data.
603 CMR 35.06 (2)(a)1

Evidence:
Fall 2015 Pre-Test
2015 ELA PARCC Test
Math Areas of Strength:
4.MD.4- (90.48%)Make a line plot to display a data set of measurements in fractions of a unit
(1/2, 1/4, 1/8). Solve problems involving addition and subtraction of fractions by using
information presented in line plots.
4.NF.3a- (80.95%)Understand addition and subtraction of fractions as joining and separating
parts referring to the same whole.
4.OA.5- (71.43%) Generate a number or shape pattern that follows a given rule. Identify
apparent features of the pattern that were not explicit in the rule itself.
Math Area of Concerns:
4.OA.4- (0%) Find all factor pairs for a whole number in the range 1-100. Recognize that a whole
number is a multiple of each of its factors. Determine whether a given whole number in the range
1-100 is a multiple of a given one-digit number. Determine whether a given whole number in the
range 1-100 is prime or composite.
4.NBT.6- (0%) Find whole-number quotients and remainders with up to four-digit dividends and
one-digit divisors, using strategies based on place value, the properties of operations, and/or the
relationship between multiplication and division. Illustrate and explain the calculation by using
equations, rectangular arrays, and/or area models.
4.NF.5- (0%) Express a fraction with denominator 10 as an equivalent fraction with denominator
100, and use this technique to add two fractions with respective denominators 10 and 100. 2

Self-Assessment Form

January 2012

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ELA Areas of Strength:

39% (7/18) of my students received a level of 4 or 5 on the 2015 PARCC Assessment.
ELA Areas of Concern:
61% (11/18) of my students received a level of 1, 2, or 3 on their 2015 PARCC Assessment.

Team, if applicable:

List Team Members below:

Self-Assessment Form
EducatorName/Title:

Janice Caron/4th Grade Teacher

Part 2: Assessment of Practice Against Performance Standards

Citing your districts performance rubric, briefly summarize areas of strength and high-priority areas for
growth. Areas may target specific Standards, Indicators, or elements, or span multiple Indicators or
elements within or across Standards. The form should be individually submitted by educator, but Part 2
can also be used by teams in preparation for proposing team goals.
603 CMR 35.06 (2)(a)2

Self-Assessment Form

January 2012

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Areas of Strength:
Ability to implement Eureka Math Program
Modify Lessons to meet students needs
Modify assessments to meet students needs
Organize a variety of activities to promote student learning
Evaluate student learning for planning purposes
Flexibility in all facets of teaching
Improving students vocabulary knowledge

High-Priority Areas for Growth:

Improve implementation of reading planner
Improve implementation of Lucy Calkins writing program
Improve implementation of C.A.F.E. strategies
Improve implementation of Daily 5

Team, if applicable:

List Team Members below:

Signature of Educator

Date

Signature of Evaluator*

Date

* The evaluators signature indicates that he or she has received a copy of the self-assessment form and the goal
setting form with proposed goals. It does not denote approval of the goals.

Self-Assessment Form

January 2012

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