School Improvement - Louisiana Department of Education

EXIT SUMMARY SHEET (SAMPLE)
School Name:
Team Leader:
Instructions:
A. Using all information gathered by the team and the end‐of‐day team debriefing, the team leader will complete
the Exit Summary Sheet. List each scientifically based research strategy and its indicators in the SIP. Summarize
the degree of evidence of implementation: For each team member who conducted classroom observations put
the number of classes in which they saw no evidence, little evidence, some evidence, and extensive evidence of
the different strategies and include notes as needed to clarify rating.
Scientifically based research strategy: __ Response to Intervention (RTI)_______________________
Indicator : 4.2 Tier 2 – Targeted Group Instruction: Target groups of students are provided with intensive
instruction matched to their needs on the basis of levels of performance and rates of progress
Observer 1
No Evidence
________
Little Evidence
_______
Some Evidence
_______
Extensive Evidence
_______
Notes:
Lesson plans: Some evidence
Teacher use: Some attempting, but very little proficiency seen. Students were instructed whole
group.
Student use: All students were required to complete the same task with no obvious
differentiation.
Teacher‐made tests: All multiple choice.
Student work: Portfolios mostly worksheets
Observer 2
No Evidence
________
Little Evidence
_______
Some Evidence
_______
Extensive Evidence
_______
Notes:
Observer 3
No Evidence
________
Little Evidence
_______
Some Evidence
_______
Extensive Evidence
_______
Notes:
Observer 4
No Evidence
________
Little Evidence
_______
Some Evidence
_______
Extensive Evidence
_______
Notes:
110