Title Page
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Conducted on
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Prepared by
School Name
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School Name
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Start Time
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End Time
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School Personnel Involved
2018-2019 Authorizer Assurances Site Visit items to review
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Authorizer Assurances Items to Review
Comments and Documentation
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Other Items Discussed
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Stakeholder Data to be Collected
- Governing Authority Members
- Staff
- Parents
- Students
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Stakeholder Interviews
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Technical Assistance and Guidance Provided
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Areas of Strength
Areas for Improvement Identified This Month
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Area for Improvement
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Action Steps Required
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Timeframe for completion
Follow -Up on Previously Identified Areas for Improvement
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Area for Improvement
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Progress of Action Steps Required:
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Timeframe for Completion
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Improvement Progress
- Unmet
- Progressing
- Met