Teacher Evaluation Request Form

Please complete this form to request a teacher evaluation. When Trying Together receives this completed form, you will receive an invoice for $400 per evaluation. Once payment is received in the Trying Together office, an evaluation will be scheduled with the evaluator and teacher. Evaluations will be scheduled as requests and payments are received.

Date

I am requesting an evaluation for (teacher name) *

Teacher Phone *

Teacher Email *

Check the appropriate boxes:

Level 1 (two per year): *

First Evaluation
Second Evaluation
N/A

Level 2 (one per year): *

First Evaluation
N/A

Please check both boxes for each Level 1 teacher. This will document your approval for each evaluation. You will be invoiced for both evaluations in the fall unless you check the box for separate fall and spring invoicing.

Invoice separately for fall and spring evaluations.

Will evaluators need to be masked in the facility? *

Yes
No

Facility Name *

Facility Director/Contact Person Name *

Facility Director/Contact Person Phone *

Facility Director/Contact Person Email *

Facility Address *

City

State/Province

Zip

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Teacher Evaluation Request Form