Candidate Assessment of Performance Form and Rubric Section 1: General Information (to be completed by the Candidate) Candidate Information First Name: Paris Last Name: Booth Street Address: 10 Buick Street City/Town: Boston MA Zip: MEPID #: 54516329 Massachusetts license n/a number(if applicable): Program Information Sponsoring Boston University Organization: Program Area & Grade Elementary Education (4th year/Senior) Level: Have any components of the approved program been waived? 603 CMR 7.03(1)(b) Yes No Practicum Information Practicum Practicum Equivalent Practicum/Equivalent Course CH555 Credit hours: 10 Number: Practicum/Equivalent Full Practicum / Student Teaching Seminar Course Title: Practicum/Equivalent Mason Rice Elementary School Grade Level(s) of Students: 5 Site: Number of hours assumed full Total Number of Practicum Hours: 300 60 responsibility in the role: Supervising Practitioner Information (to be completed by the Program Supervisor) Name: School District: Position: MEPID or License Field(s): License # # of years experience under license: Initial Professional To the best of my knowledge (per the Supervising Practitioner’s Principal/Evaluator), the Supervising Practitioner has received a Yes No summative evaluation rating of proficient or higher in his most recent evaluation.
Candidate Assessment of Performance Form and Rubric Section 1: General Information (to be completed by the Candidate) Candidate Information First Name: Paris Last Name: Booth Street Address: 10 Buick Street City/Town: Boston MA Zip: MEPID #: 54516329 Massachusetts license number(if applicable): n/a Program Information Sponsoring Organization: Boston University Program Area & Grade Level: Elementary Education (4th year/Senior) Have any components of the approved program been waived? 603 CMR 7.03(1)(b) Yes No Practicum Information Practicum Practicum Equivalent Practicum/Equivalent Course Number: CH555 Credit hours: 10 Practicum/Equivalent Seminar Course Title: Full Practicum / Student Teaching Practicum/Equivalent Site: Mason Rice Elementary School Grade Level(s) of Students: 5 Total Number of Practicum Hours: 300 Number of hours assumed full responsibility in the role: 60 Supervising Practitioner Information (to be completed by the Program Supervisor) Name: School District: Position: License Field(s): MEPID or License # # of years experience under license: Initial Professional To the best of my knowledge (per the Supervising Practitioner’s Principal/Evaluator), the Supervising Practitioner has received a summative evaluation rating of proficient or higher in his most recent evaluation. Yes No
Sample-CAP-Summative-Rubric-Elementary.docx