2023-24 Teacher Evaluation Request Form

Please complete this form to request a teacher evaluation. Please read the details below prior to completing this form.

Disclaimer: Prior to filling out this form please know the following information:

-Does the teacher you are requesting evaluations for have a Level l or Level ll ?

- Correct email address for teacher

- Program LEA/AUN

- Evaluator for the 2022-2023 year

When Trying Together receives this completed form, you will receive an invoice for $400 per evaluation. Level l teachers are supposed to receive two evaluations per year. We can't guarantee that you will receive the evaluator you had last year but we will try our best to accommodate.

Date

I am requesting an evaluation for (teacher name) *

Teacher Phone *

Teacher Email *

Program Name *

Program Address *

Program City *

Program State *

Program ZIP Code *

Check the appropriate boxes:

Level 1 (two per year): *

First Evaluation and 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

Evaluator for 2022-23 year, if applicable:

Facility Name *

Facility Director/Contact Person Name *

Facility Director/Contact Person Phone *

Facility Director/Contact Person Email *

Facility Address *

City *

State/Province *

Zip *

Program AUN/LEA: *

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2023-24 Teacher Evaluation Request Form