TEACHER:  _____________________________________  DATE:  ______________

q  SMART Goal 			q  Team-Based Student Learning Objective (SLO)

GOAL:  ______________________________________________________________

_____________________________________________________________________ 

_____________________________________________________________________

STUDENT ASSESSMENT(S) (If applicable, identify the scoring guide or rubric used):  
__________________________________   __________________________________ 
__________________________________   __________________________________ 
DESCRIPTION OF DATA
(This could include scatterplots, graphs, charts, narrative description of trends)

	OBSERVATIONS OF DATA
(If an SLO, this should include discrepancies between your assessment of student work and your team’s assessment of work.)	
NEXT STEPS
(Include what changes to your practice, interventions, or new
 goals will be implemented based on the review of this data.)

	

__________________________________________  ___________________________
Signature of Teacher					 Date

__________________________________________  ___________________________
Signature of Evaluator			 		Date