2019 CEPSE Faculty and Academic Staff Self-Evaluation Form

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Welcome to your 2019 self-evaluation! This form will be shared with the FTFAS Committee and your supervisor for peer review and evaluation. Complete the sections based on your work areas such as teaching, research, advising, and more. Your reflections will be kept private. Embrace this new review process and provide your input in a PDF file named appropriately.


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  1. CEPSE Fixed-Term Faculty and Academic Staff (FTFAS) Self-Evaluation Form 2019 Self-Evaluation of replace this text with your name Welcome to your 2019 self-evaluation! Your self-evaluation will be shared with the FTFAS Committee (for peer review) and your supervisor (for supervisor evaluation). This review and evaluation will be shared with CEPSE s Chair, along with your self- evaluation. We are using PowerPoint to collect information about your 2019 work with CEPSE. We are using PowerPoint because we think it s the best technology for our needs of collecting a variety of data numbers, words, and images. Your reflections will not be presented publicly. This annual review process is new and we appreciate your willingness to try something new! Directions Based on your work, please complete the appropriate slides. If you do not have a designated workload in a specific area (advising, teaching, etc.) based on your contract, but are doing work in the area, please complete the appropriate section to make this work visible. To support the completion of this self-evaluation, please see the FTFAS Responsibilities and Artifact Example document. Everyone should complete the Self Reflection section at the end of the slide deck. Replace blue text with your responses. Leave your responses blue. Please rename this file using the convention: Last Name_First Name_2019 CEPSE Self-Evaluation . Before submitted, please safe this file as a PDF.

  2. If you have questions about this self evaluation form, please contact a member of the FTFAS Committee. If you have questions about this self evaluation form, please contact a member of the FTFAS Committee. Name Program Email Phone Andrew Nay Rehab Counseling nayandre@msu.edu 517-432-2952 Brittany Dillman MAET/EPET dillmanb@msu.edu 517-432-4852 Candace Robertson MAET/EPET candacem@msu.edu 517-432-7195 Erin Hamilton Special Education erinhami@msu.edu 517-432-0418 Jiahang Li Confucius Institute jiahang@msu.edu 517-884-7296 Lisa Plascencia Special Education lisaplas@msu.edu 517-353-5401 Tiffany Stauch Special Education kaidtiff@msu.edu 517-432-4022

  3. Table of Contents Table of Contents Teaching Service Research Outreach Curriculum Development Advising Administration Self-Reflection (everyone completes these questions)

  4. Teaching Teaching

  5. 2019 Teaching Course Load 2019 Teaching Course Load Please fill in data that corresponds to your Spring, Summer, and Fall 2019 teaching course load. Add rows as needed. If you don t teach any online or face-to-face course, please leave it blank. Semester Course Number and Title # of credits # of students SS19 CEP XXX: Title of course in words <#> <#>

  6. 2019 Field Instruction Load 2019 Field Instruction Load Please fill in data that corresponds to your Spring, Summer, and Fall 2019 field instruction load. If you don t serve as a Special Education field instructor, please leave it blank. Number of interns you supervised Semester Briefly describe yourresponsibilities Spring 2019 <#> <replace with your words> Summer 2019 <#> <replace with your words> Fall 2019 <#> <replace with your words>

  7. 2019 Instructor Supervision & Coordination Load 2019 Instructor Supervision & Coordination Load Please fill in data that corresponds to your Spring, Summer, and Fall instructor supervision load. Number of instructors you supervised Semester Briefly describe yourresponsibilities Spring 2019 <#> <replace with your words> Summer 2019 <#> <replace with your words> Fall 2019 <#> <replace with your words>

  8. 2019 Teaching Responsibilities 2019 Teaching Responsibilities Please replace this text with your teaching responsibilities during 2019. Please see the FTFAS Responsibilities and Artifact Examples document, if needed. Add more bullet points for more teaching responsibilities.

  9. 2019 Teaching Performance Level 2019 Teaching Performance Level Based on the rubric below, please put an X in the cell that best represents your teaching in 2019. Performance Level Level 1: Unsatisfactory Level 2: Level 3: Level 4: Improvement needed Meets expectations Exceeds expectations Performance and quality of work were consistently below expectations. Performance and quality of work inconsistently met expectations. Performance and quality of work consistently met expectations. Performance and quality of work consistently exceeded expectations. Description Self-Rating

  10. 2019 Teaching Reflection 2019 Teaching Reflection Please replace this text with a brief explanation (roughly 100-200 words) that supports your self-rated performance level and describes how you fulfilled your responsibilities within teaching in 2019.

  11. Teaching Artifact Teaching Artifact Please replace this text with an explanation of the artifact you ve shared with us. *SIRS for each course you ve taught during 2019 will be uploaded by the department and does not need to be submitted as an artifact. Place an image of your artifact here!

  12. Service Service

  13. 2019 Service Responsibilities 2019 Service Responsibilities Please replace this text with your service responsibilities during 2019. Please see the FTFAS Responsibilities and Artifact Examples document, if needed. Add more bullet points for more service responsibilities.

  14. 2019 Service Performance Level 2019 Service Performance Level Based on the rubric below, please put an X in the cell that best represents your service in 2019. Performance Level Level 1: Unsatisfactory Level 2: Level 3: Level 4: Improvement needed Meets expectations Exceeds expectations Performance and quality of work were consistently below expectations. Performance and quality of work inconsistently met expectations. Performance and quality of work consistently met expectations. Performance and quality of work consistently exceeded expectations. Description Self-Rating

  15. 2019 Service Reflection 2019 Service Reflection Please replace this text with a brief explanation (roughly 100-200 words) that supports your self-rated performance level and describes how you fulfilled your responsibilities within service in 2019.

  16. Service Artifact Service Artifact Please replace this text with an explanation of the artifact you ve shared with us. Place an image of your artifact here!

  17. Research Research

  18. 2019 Research Responsibilities 2019 Research Responsibilities Please replace this text with your research responsibilities during 2019. Please see the FTFAS Responsibilities and Artifact Examples document, if needed. Add more bullet points for more research responsibilities.

  19. 2019 Research Performance Level 2019 Research Performance Level Based on the rubric below, please put an X in the cell that best represents your research in 2019. Performance Level Level 1: Unsatisfactory Level 2: Level 3: Level 4: Improvement needed Meets expectations Exceeds expectations Performance and quality of work were consistently below expectations. Performance and quality of work inconsistently met expectations. Performance and quality of work consistently met expectations. Performance and quality of work consistently exceeded expectations. Description Self-Rating

  20. 2019 Research Reflection 2019 Research Reflection Please replace this text with a brief explanation (roughly 100-200 words) that supports your self-rated performance level and describes how you fulfilled your responsibilities within research in 2019.

  21. Research Artifact Research Artifact Please replace this text with an explanation of the artifact you ve shared with us. Place an image of your artifact here!

  22. Outreach Outreach

  23. 2019 Outreach Responsibilities 2019 Outreach Responsibilities Please replace this text with your outreach responsibilities during 2019. Please see the FTFAS Responsibilities and Artifact Examples document, if needed. Add more bullet points for more outreach responsibilities.

  24. 2019 Outreach Performance Level 2019 Outreach Performance Level Based on the rubric below, please put an X in the cell that best represents your outreach in 2019. Performance Level Level 1: Unsatisfactory Level 2: Level 3: Level 4: Improvement needed Meets expectations Exceeds expectations Performance and quality of work were consistently below expectations. Performance and quality of work inconsistently met expectations. Performance and quality of work consistently met expectations. Performance and quality of work consistently exceeded expectations. Description Self-Rating

  25. 2019 Outreach Reflection 2019 Outreach Reflection Please replace this text with a brief explanation (roughly 100-200 words) that supports your self-rated performance level and describes how you fulfilled your responsibilities within outreach in 2019.

  26. Outreach Artifact Outreach Artifact Please replace this text with an explanation of the artifact you ve shared with us. Place an image of your artifact here!

  27. Curriculum Development Curriculum Development

  28. 2019 Curriculum Development Responsibilities 2019 Curriculum Development Responsibilities Please replace this text with your curriculum development responsibilities during 2019. Please see the FTFAS Responsibilities and Artifact Examples document, if needed. Add more bullet points for more curriculum development responsibilities.

  29. 2019 Curriculum Development Performance Level 2019 Curriculum Development Performance Level Based on the rubric below, please put an X in the cell that best represents your curriculum development in 2019. Performance Level Level 1: Unsatisfactory Level 2: Level 3: Level 4: Improvement needed Meets expectations Exceeds expectations Performance and quality of work were consistently below expectations. Performance and quality of work inconsistently met expectations. Performance and quality of work consistently met expectations. Performance and quality of work consistently exceeded expectations. Description Self-Rating

  30. 2019 Curriculum Development Reflection 2019 Curriculum Development Reflection Please replace this text with a brief explanation (roughly 100-200 words) that supports your self-rated performance level and describes how you fulfilled your responsibilities within curriculum development in 2019.

  31. Curriculum Curriculum Development Artifact Development Artifact Please replace this text with an explanation of the artifact you ve shared with us. Place an image of your artifact here!

  32. Advising Advising

  33. 2019 Advising Responsibilities 2019 Advising Responsibilities Please replace this text with your advising responsibilities during 2019. Please see the FTFAS Responsibilities and Artifact Examples document, if needed. Add more bullet points for more advising responsibilities.

  34. 2019 Advising Performance Level 2019 Advising Performance Level Based on the rubric below, please put an X in the cell that best represents your advising in 2019. Performance Level Level 1: Unsatisfactory Level 2: Level 3: Level 4: Improvement needed Meets expectations Exceeds expectations Performance and quality of work were consistently below expectations. Performance and quality of work inconsistently met expectations. Performance and quality of work consistently met expectations. Performance and quality of work consistently exceeded expectations. Description Self-Rating

  35. 2019 Advising Reflection 2019 Advising Reflection Please replace this text with a brief explanation (roughly 100-200 words) that supports your self-rated performance level and describes how you fulfilled your responsibilities within advising in 2019.

  36. Advising Artifact Advising Artifact Please replace this text with an explanation of the artifact you ve shared with us. Place an image of your artifact here!

  37. Administration Administration

  38. 2019 Administration Responsibilities 2019 Administration Responsibilities Please replace this text with your administrative responsibilities during 2019. Please see the FTFAS Responsibilities and Artifact Examples document, if needed. Add more bullet points for more administrative responsibilities.

  39. 2019 Administration Performance Level 2019 Administration Performance Level Based on the rubric below, please put an X in the cell that best represents your administration performance in 2019. Performance Level Level 1: Unsatisfactory Level 2: Level 3: Level 4: Improvement needed Meets expectations Exceeds expectations Performance and quality of work were consistently below expectations. Performance and quality of work inconsistently met expectations. Performance and quality of work consistently met expectations. Performance and quality of work consistently exceeded expectations. Description Self-Rating

  40. 2019 Administration Reflection 2019 Administration Reflection Please replace this text with a brief explanation (roughly 100-200 words) that supports your self-rated performance level and describes how you fulfilled your responsibilities within administration in 2019.

  41. Administration Administration Artifact Artifact Please replace this text with an explanation of the artifact you ve shared with us. Place an image of your artifact here!

  42. 2019 Self 2019 Self- -Reflection Reflection

  43. As you reflect on your overall performance, what did you do well within your assigned duties in 2019? Replace this with your response.

  44. What growth goals, if any, were identified in your prior review, and what is your assessment of your progress on these goals? Replace this with your response.

  45. In what areas would you like to focus on for professional growth in the upcoming year? What support do you need for that? Replace this with your response.

  46. What types of professional development did you attend in 2019? What are you interested in/feel that you should attend? Replace this with your response.

  47. Through the review process, it is the hope of the FTFAS Committee to create a space for conversation around discrepancies in defined contract percentages and actual work performed so that contracts can better reflect actual responsibilities. If you completed any additional work or have responsibilities that do not currently fit under your assigned workload, please list those categories (teaching, service, research, outreach, curriculum development, advising, administration). Replace this with your response.

  48. Regarding the additional tasks and responsibilities on the previous slide, please share what the impact of these additional tasks and responsibilities is on the program, Department, College, University, or profession? Replace this with your response.

  49. Please share 1 actionable goal that you would like to work toward in 2020. Replace this with your response.

  50. Reminder Reminder Please rename this file using the convention: Last Name_First Name_2019 CEPSE Self-Evaluation . Please save this file as a PDF Please save this file as a PDF. Upload to Qualtrics.

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