Rural Providers Conference

• Class name/number

• Instructor

• Campus

• Conducted on

  Date

• Conducted by

• 5 = Exceeds expectations on a consistent and uniform basis
  4 = Meets and frequently exceeds performance standards
  3 = Successfully meets performance expectations
  2 = Fails to meet performance expectations
  1 = Does not meet goals and objectives

Personal Traits

• Instructor appearance

  5

  4

  3

  2

  1

• Instructor enthusiasm

  5

  4

  3

  2

  1

• Instructor choice, use of words

  5

  4

  3

  2

  1

• Instructor enunciation

  5

  4

  3

  2

  1

• Instructor quality, volume of voice

  5

  4

  3

  2

  1

• Instructor eye contact

  5

  4

  3

  2

  1

• Instructor body mannerisms

  5

  4

  3

  2

  1

• Instructor confidence

  5

  4

  3

  2

  1

• General comments about Instructor's personal traits

Relationship with attendees

• Distribution of questions, attention

  5

  4

  3

  2

  1

• Knowledge of names

  5

  4

  3

  2

  1

• Class control

  5

  4

  3

  2

  1

• Attention to feedback

  5

  4

  3

  2

  1

• Response to needs, difficulties

  5

  4

  3

  2

  1

• Instructor's tact

  5

  4

  3

  2

  1

• Instructor use of humor

  5

  4

  3

  2

  1

• General comments about Instructor's relationship with his/her students

Lesson Evaluation

• Communication of learning goals

  5

  4

  3

  2

  1

• Instructor's motivation, interest arousal

  5

  4

  3

  2

  1

• Review of prerequisites

  5

  4

  3

  2

  1

• Sequencing

  5

  4

  3

  2

  1

• Clarity of explanation

  5

  4

  3

  2

  1

• Explanation of unfamiliar terms

  5

  4

  3

  2

  1

• Attention to previous knowledge level of students

  5

  4

  3

  2

  1

• Effective utilization of training aids

  5

  4

  3

  2

  1

• Picture of training aids used (dry erase boards, Power Point presentations, smart boards, etc.)

  Media

• Questioning techniques

  5

  4

  3

  2

  1

• Emphasis on "why" and application

  5

  4

  3

  2

  1

• Opportunity for proper note taking

  5

  4

  3

  2

  1

• Opportunity for practice, assimilation

  5

  4

  3

  2

  1

• Adequacy of lesson summary

  5

  4

  3

  2

  1

• Evaluation methods

  5

  4

  3

  2

  1

• Accomplishment of the lesson's objectives

  5

  4

  3

  2

  1

Instructor preparation

• Clarity of objectives

  5

  4

  3

  2

  1

• Adequacy of lesson plan

  5

  4

  3

  2

  1

• Choice of methods and materials

  5

  4

  3

  2

  1

• Readiness of equipment, facilities

  5

  4

  3

  2

  1

• Picture of classroom

  Media

• Quality of hand-outs, Power Point presentations, etc

  5

  4

  3

  2

  1

• Picture of hand-outs, Power Point presentations, etc.

  Media

• General comments about the Instructor's preparation for class

Standards

• Was class held for the scheduled time?

  Yes

  No

  N/A

• Did the Instructor adhere to the scheduled student breaks?

  Yes

  No

  N/A

• Did the Instructor post attendance as prescribed by Home Office?

  Yes

  No

  N/A

• Was the classroom neat and orderly?

  Yes

  No

  N/A

• Was all equipment in the classroom functioning properly?

  Yes

  No

  N/A

• Did the Instructor use approved instructional plans?

  Yes

  No

  N/A

• Did the Instructor utilize available technology?

  Yes

  No

  N/A

• Was the Instructor prepared for class?

  Yes

  No

  N/A

• Were the students in dress code?

  Yes

  No

  N/A

• Was the temperature of the classroom conducive to a good learning environment?

  Yes

  No

  N/A

• Was the classroom well lit?

  Yes

  No

  N/A

• Additional comments

• Quality Assurance Team Member

  Sign