Performance Task 3
Accomplish the Teaching Internship Evaluation form and detach this page and
submit to your College Supervisor.
Teaching Internship Evaluation Form
(For Practice Teacher’s Use)
A. Respondent’s Profile
Instructions: Kindly supply the data asked and mark the appropriate information on the
blank provided for. Your answer will be highly appreciated.
Name ___________________________________________________________________
SURNAME GIVEN NAME
MAIDEN/MIDDLE
Name / Address of Cooperating School
___________________________________________________________
Type of School: Private Sectarian _____________ Private Non-Sectarian ______________
Public ____________
Other please specify: ______________
Grade / Year Level / Taught
Pre School High School
Elementary Special Education
Others, please specify
Subject Taught
________ Filipino
________ English
________ Science
________ Math
________ Social Science
________ All Subject in Pre-elem
________ Others (pls, specify)
Numbers of Hours Rendered
________ 100-150 hours ________ 251-300 hours
________ 151-200 hours ________ over 301 hours
________ 201-250 hours
B. Practicum Experiences
Instruction: The purpose of this evaluation is to gain feedback regarding the quality of your
teaching internship.
The concerns noted will initiate corrective action to improve the quality of the learning
experiences.
Your honest answer to this questionnaire will be highly appreciated. Please rate the
items using the
given scale:
5- Excellent 4- Very Good 3- Good 2- Fair
1- Needs Improvement
Orientation Activities 5
Excelle
nt
Very
Good
Good
Fair
Needs
Impr
ovem
ent
1 Orientation of the Practice Teacher by the
practicum supervisor on Practice Teaching ✔️
2 Orientation of the Practice Teacher with the
Cooperating Principal ✔️
3 Orientation of the Practice Teacher with the
Cooperating Teacher ✔️
4 Familiarization of the Practice Teacher in
School Facilities/Equipment ✔️
5 Orientation on the School Rules and Policies ✔️
6 Required Practicum Students Form ✔️
7 Practicum Experience of the Practice Teacher ✔️
8 Consultation time with the cooperating
teacher ✔️
9 Assistance in Writing lesson plans ✔️
10 Providing feedbacks on the practice teacher’s
competencies ✔️
11 Meeting with the cooperating teachers on
schedule basis ✔️
12 Giving instructions on classroom routines ✔️