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Narrative Statement:  Please write a narrative statement describing this person’s competence as a preprofessional teacher based on your observations and professional judgment to date.  Attach an additional (or separate) page if necessary.

Location of Student Teaching:  School: _________________________________________

City, State: ______________________________________

PLEASE OBTAIN ALL SIGNATURES BEFORE FORWARDING THIS EVALUATION TO THE UW FACULTY/CONSULTANT

Complete by: ________________________________Date: ___________________

Signature of mentor teacher

________________________________Date: ___________________

Signature of student teacher

Received by:________________________________Date: ___________________

Signature of UW Faculty/Consultant

PLEASE INITIAL ONE OF THE TWO CHOICES BELOW:

_____ I would like this student teaching evaluation to be included in my placement file.

_____ I WOULD NOT like the student teaching evaluation to be included in my placement file.

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