Download the following forms and take them to your mentor teacher to evaluate your performance as a clinical teacher and the performance of your university field supervisor.  Your mentor teacher will return these documents directly to the Center for the Preparation of Professional Educators. We strongly encourage you to take a pre-addressed envelope to your mentor teacher to assure the forms are returned in a timely manner.  

Forms are submitted to: 

Olivia Elmore, Ph.D.

Director of Clinical Teaching & Field Experiences

Houston Baptist University

School of Education

7502 Fondren Road

Houston, TX 77074-3298

Instructions: The student will respond to each variable on this self-report scale by placing an X by the rating that best describes his/her behavior in the course that he/she is currently enrolled. The ratings are 3 = Target, 2 = Acceptable, and 1 = Unacceptable. The total number of points that may be earned range from 7-21. Points from 18-21 indicate that the student’s performance is On Target. Points from 14-18 indicate that overall performance is Acceptable. Points from 10-14 indicate that Improvement is Encouraged. Points at 9 or below indicate Unacceptable performance. Your professor will review your responses and agree or disagree with the findings. If your professor determines that you have Unacceptable performance in any area, it is your responsibility to provide evidence that you have Acceptable or Target performance. You will arrange to meet with the instructor during the instructor’s office hours or an agreed upon time within 1 week if total points are below 14 or there is any rating of “1.”