College of Education Division of Teacher Education

Clinical Coordinators Office 1000 E. Victoria Street, Carson, CA 90747

(310) 243-2531 ∙ (310) 243-3131

Single Subject Supervisor Fieldwork Completion Checklist

Name of Intern ______________________

Student ID#

ITEMS COMPLETED (√)

Student Fieldwork Information Sheet (Student will give one copy to Clinical Support Coordinator/One copy to their supervisor)

DOTI - Observation Script (6) _____________________

Intern mentoring and Support Log _____________________

Support Provider (Agreement/Consent Form) RETURN TO DAWN BY 2/11/19

Support Provider Information Instructions (Please give this form to your support provider ASAP to input their information using the link) DO NOT TURN IN

Support Provider (Disposition Form) _____________________

Supervisor Letter of Recommendation (2*) ______________________

BCLAD Competencies Met (if applicable)

TASK STREAM EVALUATION REQUIREMENTS – SEE ATTACHED CHART:

I certify that all requirements (circle one) have/have not been met.

Supervisor Signature ________________________________________________Date _________________

Coordinator Signature Date *One copy to the Student / One copy to the Supervisor

vdc 09/18

TASK STREAM EVALUATION REQUIREMENTS

First Semester: TED Field Work I Second Semester: TED Fieldwork II Intern Mentoring and Support Log Intern Mentoring and Support Log Demographic/Funds of Knowledge Demographic/Funds of Knowledge Parent Conference Parent Letter 1 Observation Lessons 1-6 Parent Letter 2 Official Reflections 1-6 Participation in Parent Conference Reflective Journal (Submitted to Observation Lessons 1-6

supervisor, not Taskstream) Official Reflections 1-6 Supervisor Survey Reflective Journal (Submitted to

supervisor, not Taskstream) Supervisor Survey

TEACHER EDUCATION DEPARTMENT – SINGLE SUBJECT FIELDWORK INFORMATION OFFICE USE ONLY

SUPERVISOR ASSIGNED: ADMIT REGISTERED

STUDENT INFORMATION Last Name:

First Name: ID#:

Home Address___________________________________________________City_______________________Zip Code_____________ Home Phone( )______________________Cell Phone( )______________________Email________________________________ Fall_____ Spring_____ Year _______ Fieldwork I_____or Fieldwork II_____ EL/CLAD______ BCLAD______ Have you completed BCLAD Emphasis? Yes______ No______ If yes, periods of Bilingual Classes_________________________ Subject Area(s)__________________________________________ Grade Level_________

SCHOOL INFORMATION School Name:

School District/Cluster:

School Address__________________________________________________City_______________________Zip Code_____________ School Phone( )______________________ School Principal/School Site Evaluator_______________________________________ Is it a Year-Round School? Yes______ No______ If yes, Track Letter and Dates__________________________________ When do you go Off-Track?___________________________

DIRECTIONS TO SCHOOL SITE FROM UNIVERSITY (please be specific) _______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

Nearest Freeway Intersections _____________________________________________________________________________________

DAILY SCHEDULE (include all subjects, recess, lunch, preparation time, etc.) Period Time Room Subject or Activity Grade Level

College of Education

Division of Teacher Education

Description of Teaching Index (DOTI) Candidate Name: SID: Date of Observation: Observation #

TPEs to be Measured Consultation Comments (Sup) Reflections

Time

Observations

Post-observation comments, reflections & TPEs Met

Candidate Signature: Supervisor Signature: Date:

Description of Teaching Index (DOTI) Candidate Name: SID: Date of Observation: Observation #

Candidate Signature: Supervisor Signature: Date:

Time

Observations

Post-observation comments, reflections & TPEs Met

CSU Dominguez Hills - Intern Support and Supervision Requirements

Background: Pursuant to state statue, the supervision and support of interns is the responsibility of both the Commission-approved teacher preparation program and the employer. A minim\im of 144 hours of support/mentoring and supervision shall be provided to each intern teacher per school year. An additional 45 hours of support/mentoring and supervision per school year is required for interns without a valid English learner authorization listed on a previously obtained credential (i.e., multiple subject, single subject, or education specialist), a valid English learner or CLAD (Crosscultural, Language and Academic Development authorization, or passage of the CTEL (California Teaching of English Learner)

examinations. (CTC-Program Sponsor Alert 13-06, June 3, 2013).

Intern Instructions: Please record time spent i~ any of the following activities on the Excel spreadsheet provided (See InternLog tab below). The

minimum requirement is 72 hours of support for all intern candidates each semester (a minimum of 2 hours each week). Any intern not already posse5sing specialized EL training needs to record and additional 22.5 hours of support focused on teaching English learners each semester.

Support/Supervision Activities. There does not need to be an entrv for each activitv. . ~ Potential Support & Supervision Activities most likely to be provided through the Intern's Employer

1. Content Specific Coaching (for example: math coaches, reading coaches, EL coaches* 2. Grade Level or Department Meetings related to curriculum. Planning, and/or instruction 3. New Teacher Orientation 4. Coaching (not evaluation) from Administrator 5. Co-planning with Special Educator or EL expert to address included special needs students and/or English learners* 6. Logistical help before and during school year (bulletin boards, seating arrangements, materials acquisition, parent conferences) 7. Release time for participation in district group/regional group (ELAC, Council for Exceotional Children)*

Potential Support and Supervision Activities most likely to be Provided throui;i:h Iiitern's Commission Approved Preparation Proe:ram 8. Seminars (problem solving issues with students, curriculum, instruction, TPEs, etc) offered in person, or via the web-enabled video conference/webinar or other video conferencing media* 9. Peer/Faculty Support (example: discussion debriefing teaching dav at start of each class)

10. Provide access/student memberships for participation in district /regional groups (ELAC committee, Council for Exceptional Children, etc.)*

Potential Support and Supervision Activities by Either or Both the Intern's Employer and Commission Approved Preparation Program 11. Classroom Observations and Coaching* 12. Demonstration Lessons and/or Co-teaching activities with mentor. coach. or program supervisor* 13. Intern Observation of other teachers and classrooms*

14. Email, Phone (voice, text), and/or video conferencing support related to observation, problem-solving, planning, curriculum and/or instruction*

15. Activities/workshops specifically addressing issues in the intern's classroom-co-attended bv intern and suoport person(s) 16. Watching and discussing teaching videos with support person (s)* 17. Interactive Journal (Support/ Supervisor and Intern) 18. Phone/Email Support Hotline* 19. Observe SDAIE/ELD lessons online or in person*

* May also oe used towards the 45-hour EL Support Supervision Requirement

'

November 2015

CSU Dominguez Hills - Intern Support and Supervision Requirements 20. 21. 22. 23. Review test results*

* May also be used towards the 45-hour EL Support Supervision Requirement November 2015

Intern Mentoring and Support Log Student ID

Intern Name School Site/District Credential Program English Learner Authorization Yes No

District Mentor For Time Period From 1/0/00 to 1/0/00 University Supervisor Total Hours of Mentor/Support 0:00

English Activity Language Activity Start Activity End

Date Examples Provider Support Time . Time Time University/$upervis · · '

.. .

MM/DDNY -

· Lesson Observations & Debrief or No 10:00AM 12:00 PM . 2:00 University/Supervis

MM/DDNY Fieldwork Seminars or No 7:00 PM 9:45 PM 2:45 .,

"

MM/DDNY Grade Level, Dept, School Site Me,etlngs Employer No ; 3:00 PM 4:30 PM 1:30 University/Supervis

MM/DDNY Email, Phone (voice/text), Video Contacts or Yes 8:00AM 8:30AM 0:30 MM/bONY · Professional Development Employer Yes 8:00AM 3:00PM 7:00

0:00 o:oo·• ..

0:00 "i ' , .GJ;OO . · .

0:00

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0:00 ..

0:00 ' .. 0:00

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0:00 . . 0:001

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0:00 .. . . . ·{ ))00: , . ' . ' . Totals 0:00

Intern Mentoring and Support Log Student ID

Intern Name School Site/District Credential Program English Learner Authorization Yes No

District Mentor For Time Period From: To:

University Supervisor Total Hours of Mentor/Support

English Language Activity Start Activity End

Date Activity Provider Support Time Time Time

''

-•.

' Totals

Intern Mentoring and Support Log '

Student ID Intern Name School Site/District

Credential Program English Learner Authorization Yes No District Mentor For Time Period From: To:

University Supervisor Total Hours of Mentor/Support

English Language Activity Start Activity End

Date Activity Provider Support Time Time Time -

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Totals

Intern Mentoring and Support Log Student ID

Intern Name School Site/District Credential Program English Learner Authorization Yes No

District Mentor For Time Period From: To: University Supervisor Total Hours of Mentor/Support

English Language Activity Start Activity End

Date Activity Provider Support Time Time Time "

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Totals

Intern Mentoring and Support Log Student ID

Intern Name School Site/District Credential Program English Learner Authorization Yes No

District Mentor For Time Period From: To: University Supervisor Total Hours of Mentor/Support

English Language Activity Start Activity End

Date Activity Provider Support Time Time Time

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Totals ·

College of Education Division of Teacher Education

Clinical Coordinators Office 1000 E. Victoria Street, Carson, CA 90747

(310) 243-2648 ∙ (310) 217-6936

Support Provider Program Agreement/Consent Form

We, the undersigned Support Provider and Intern agree to abide by the following guidelines:

• Collaboratively complete the Classroom, School, District and Community Forms(CSDC).

• Collaboratively complete the Intern Individual Action Plan.

• Meet twice weekly at a mutually agreed upon time (e-mail, face-to-face, andtelephone conversations constitute a meeting).

• Jointly complete a reflective log at the end of each meeting.

• Observe Support Provider or other veteran teacher twice each semester.

• Support Provider to observe the Intern at least once each semester.

Support Provider Name: _________________________

Signature: _________________________ Date: _________________________

Intern Name: _________________________

Signature: _________________________ Date: _________________________

PLEASE RETURN TO CLINICAL SUPPORT COORDINATOR IN COE 1401 OR VIA EMAIL @ vcook@csudh.edu

By 02/11/19

College of Education

Division of Teacher Education Clinical Coordinators Office

1000 E. Victoria Street, Carson, CA 90747 (310) 243-2648 ∙ (310) 217-6936

January 17, 2019

Dear Support Provider, Thank you for generously supporting the CSUDH Multiple and Single Subject Program by working with one of our highly qualified interns. We appreciate your willingness to share your expertise in order to support and guide the development of this intern candidate. The state requires that we collect information about our intern support providers in order to maintain our certification. In addition, we strive to provide our intern support providers with information about professional development activities and other educational opportunities at the university. To this end we ask that you complete an intern support information sheet on line using the following link: https://www.surveymonkey.com/r/MTISPInformation We greatly appreciate the partnership we have with you and your dedication to assisting us with the preparation of our teachers. With much appreciation, Cristina Stephany Ruben Hernandez Clinical Coordinator of MS/SS Student Facilitator of MS/SS Student Teachers and District Interns Teachers and District Interns

Intern Name: _________________________________ School Site: __________________________________ Support Provider Name: __________________________________ Support Provider Disposition – Multiple Subject & Single Subject: TED 445 & TED 465 Fieldwork I At the beginning of the semester, the supervisor must provide this document to the Support Provider to evaluate the intern based on the following rubric. The supervisor will collect the scored document and input the Support Provider’s scores within Taskstream. Needs Improvement Emerging Novice Novice Critical Pedagogy - empowering students to shape their learning experiences

•Several students are not engaged in the lesson •Learning tasks are not culturally relevant to the student population, and task do not build upon one another. •Little to no strategies are provided for instruction and/or assessment •No feedback is given to students during the lesson

•Students are engaged in their own learning and understand that learning is a process; the classroom climate promotes fairness and respect for all students. •Learning tasks are authentic, culturally relevant to the student population, develops students’ critical consciousness and builds upon each other to accomplish the learning goal •A few strategies for instruction and/or assessment are included to assist English Learners and students with special needs. •General feedback is given to students (does not include feedback such as “good job”, “keep working”, etc.) during the lesson to guide their learning

•Students are actively engaged in their own learning and understand that learning is a process; the classroom climate promotes fairness and respect for all students. •Learning tasks are authentic, include interests and funds of knowledge of students, are culturally relevant to the student population, justice oriented, include another content area, develops students’ critical consciousness and builds upon each other to accomplish the learning goal •Multiple strategies for instruction and assessment are included to assist English Learners and students with special needs. •Constructive feedback is given to students during the lesson to guide their learning

Rigorous Learning - meeting the needs of learners to facilitate learning

•Lesson includes an individual source of information and requires students to use the information for the task(s). •Lesson does not includes background knowledge or interests of students •Lesson does not provide opportunities for students to respond to and ask questions

•Lesson includes an individual source of information and requires students to use the information for the task(s). Adapts lesson to accommodate most students in the classroom and is delivered in multiple modalities for access •Lesson includes background knowledge or interests of students •Lesson provides opportunities for

•Lesson includes a range of sources of information and requires students to use information from sources for relevant, real world tasks •Adapts lesson to accommodate all students in the classroom and is delivered in multiple modalities for access •Lesson includes background

students to respond to and ask a range of questions that increase in rigor and levels of thinking

knowledge and interests of students •Lesson provides opportunities for students to respond to and ask a range of questions that increase in rigor and levels of thinking

Collaboration - to develop social capital

•Lesson does not include student collaboration •Students do not have the opportunity to ask and/or answer questions •The classroom culture does not encourage students to participate

•Students cooperate with one another for a common goal. •Students appear confident when collaboration with others, answering questions when called upon by the teacher and understands the rules and procedures dictated by class and school rules. •The classroom culture encourages students to participate without repercussions

•Students trust and cooperate with one another for a common goal. •Lesson conveys skills, knowledge and experiences as a means to mitigate disparities in student achievement •Students appear confident when collaboration with others, answering questions when called upon by the teacher and understands the rules and procedures dictated by class and school rules. •The classroom culture encourages and demonstrates a critically participatory ecology that does not derogate or disparage any member

Reflective Practice - practice mindfulness and reflection

•No evidence of student work as a reference to the observed lesson •Candidate does not exhibits a change in their instruction (method, pacing, and curriculum) to meet the needs of the students.

•Lesson builds upon previous class work and provides evidence of student work as a reference to the observed lesson •Candidate exhibits a change in their instruction (method, pacing, and curriculum) to meet the needs of the students. •Lesson is contextual, and provides students with multiple perspectives based on the interests of the students.

•Lesson clearly embodies active, persistent, and careful consideration of the students from past lessons and class work. •Candidate provides evidence of past student work as a reference to the observed lesson. •Candidate exhibits a change in their instruction (method, pacing, and curriculum) to meet the needs of the students. •Lesson is contextual, and provides students with multiple perspectives based on intellectual curiosity and interests of the students.

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A trusttns relationship • Using pod listening sl'cills • ·Empathetic accept:an'te • Congruence between body language

and verbal language

Clearly ~ned rotes and expectations • Desire to promote the t~acher's

autonomy and uniqueness • Nonj.udgment.al conversation

. •Honesty

Linpistk ~lls • Paraphruing • Clarifying • Pausing and wing silence • Mediational questioning

Clarifying communicata that the li$Ulner has ••. HE.ARO what the speaker said, but d()es NOT fully UNDERSTAND what was said

Oarifying involves ASK1Nc; A QUESTION (direct or implied} to

l. Gamer more information 2. Discover the .meaning of laiwage U$~ 1. Get darilJ about the spqkef'oS reasoomg 4. Seek connections between ideas 5. Develop or maintain a focus

Some possibte clarifying ~ms include the following: Wot;ild J-013 tell me il litde more abelll: .. . ? !;.et iQe' se~ if I underuam.t •.. I'd be interested in heating more about •.. It wowld help me understand if you'd give me an ~ample of .•. So, are- you saying/suggesting .. . ? TelJ me What yQu l'Qe;jn wf:ien you ••. Tell m~ b'Qw that Idea ls like (different from) ... To wft't extent ... ? · I'm curious to know more about .•. I'm intrigued by ... I I'm interested in . . . / I wonder . .

NOTE: 'Why?" tends to elicit a defensive response

- - -

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Pa~f!.A$ing ~Jl\~ur\i.Q.tes tbat~·ei Osten-er has ... HEARD Wfiat the speaker said. ':'ND&-,,T-000 what~ said, and CABE5

Parapjlmipg jPv~ either: U$TA'11N<; i.n your own words, or s~MAil~G

·some pe~ibf1'. p{lraphn.sing stems include the 'following: So,.·. . . In other. W.Ol'ds, •• • What l'.m hearing then •.. What 1. h!l!tr ~.u ~PJ ... Frem w1- I hear ycu say ••• l'l'f:I heariJig ~Ry thin~ ••. As I lineri to you I'm hearing •.•

Medll,lional quemons. help the ~olleape HY-PonGSJZE wlrat ml&ht happen ANAi.YU. wfQt vtor~ or didn't IMAGIN~ possibilitlu

• ·COMPAQ & CONTRAS~ what was planned With what ensued· EXTBAPOE.ATE from; one situation to another EVAUJATe the imp~

Some mediaticmal qu~stion stems include ••. What's an~er..,.,..,, )'Ou might .•• ? What woiild it look like if ... ? What do )'9tt think woatd happen if •.. ? How was •.. different frcim ~ib.~ ... l WMi'S another W11f you mi&hf •.• i Wh:i.t sort of an impact do you think •.• ? What criteria do yau use to ... ? When haYe you done something like •.. before? What do )OU. thilik •.. l H.ow didtpl:4 decide ••• (.come to that conclusionl) What mizh~ _you se happenir:!l ih 'your . classroom if ••. r

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