Author: admin

Allen County Schools Speech Therapist - Post-Observation Conference Form

Speech Therapist
School
Grade Level(s)
Evaluator
Date of Conference

Evaluator’s Formative Observation Rating: Other professionals may request the evaluator provide
examples of evidence used to support the rating

Domain 2: The Environment	Rating	Domain 3: Delivery of Service	Rating
A: Establishing Rapport with Students		A: Responding to Referrals and Evaluating Student Needs
B. Organizing Time Effectively		B. Developing and Implementing Treatment Plans
C. Establishing and Maintaining Clear Referral Procedures		C: Communicating with Families
D: Establishing Standards of Conduct in Treatment Center		D: Collecting Information; Writing Reports
E. Organizing Physical Space		E: Demonstrating / Flexibility and / Responsiveness

I	D	A	E	NA
I	D	A	E	NA
I	D	A	E	NA
I	D	A	E	NA
I	D	A	E	NA

I	D	A	E	NA
I	D	A	E	NA
I	D	A	E	NA
I	D	A	E	NA
I	D	A	E	NA

Domain 1: Planning and Preparation	Comments / Ratings:

Domain 4: Professional Responsibilities	Comments / Ratings:

_____________________________________ _____________________ _____________________________________ _____________________
Speech Therapist’s Signature Date Evaluator’s Signature Date
*Denotes sharing of results, not necessarily agreement with the formative rating. The therapist may submit a response in writing to all ratings by the evaluator.

Opportunities for an appeal are part of the Allen County School District evaluation plan
A copy of the completed form must be provided to the speech therapist