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    Rev 2/05 by OSPI
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    D
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    State of Washington
    Directions.
    Before you begin to fill out this form, please read all information describing
    standards, criteria, and indicators related to the Professional Certificate.
    (1) Name of Candidate
    Last
    First
    Middle
    (2) Home Address
    Number
    Street
    Apt. No.
    City
    State
    Zip Code
    (3) Daytime Phone No. (
    )
    (4) Social Security No. (
    )
    (5)
    (6) Name each College/University Professional Growth Advisor who has advised you.
    Advisor
    Name of Pre-Assessmt Instr.
    Institution
    WWU
    Dates: Start & End Dates
    Candidate
    completes
    this section.
    Identify Each
    Endorsement
    on your
    Certificate
    Advisor
    Institution
    Dates
    Advisor
    Institution
    Dates
    Candidate retains original copy of Professional
    Growth Record for inclusion in portfolio.
    Copy sent to University-School Partnerships.
    Page 2 of2
    Rev 2/05 by OSPI
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    S
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    O
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    N
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    D
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    Approval of
    Core Activities
    Verification of Completed
    Activities
    Standard/Criterion
    Date
    Advisor
    Initials
    Date
    Advisor Initials
    Effective Teaching
    (i) Using instructional strategies that make learning meaningful
    and show positive impact on student learning
    1/15/07
    L.W.
    3/16/08
    N.S.
    (ii) Using a variety of assessment strategies and data to monitor
    and improve instruction
    3/16/08
    N.S.
    (iii) Using appropriate classroom management principles,
    processes and practices to foster a safe, positive, student-
    focused learning environment
    3/16/08
    N.S.
    (iv) Designing and/or adapting challenging curriculum that is
    based on the diverse needs of each student
    3/16/08
    N.S.
    (v) Demonstrating cultural sensitivity in teaching and in
    relationships with students, families, and community members
    3/16/08
    N.S.
    (vi) Integrating technology into instruction and assessment
    3/16/08
    N.S.
    (vii) Informing, involving, and collaborating with families and
    community members as partners in each student’s educational
    process, including using information about student
    achievement and performance.
    1/15/07
    L.W.
    3/16/08
    N.S.
    Professional Development
    (i) Evaluating the effects of his/her teaching through feedback
    and reflection;
    3/16/08
    N.S.
    (ii) Using professional standards and district criteria to assess
    professional performance, and plan and implement appropriate
    growth activities
    3/16/08
    N.S.
    (iii) Remaining current in subject area(s), theories, practice,
    research and ethical practice
    1/15/07
    L.W.
    3/16/08
    N.S.
    Professional Contributions
    (i) Advocating for curriculum, instruction, and learning
    environments that meet the diverse needs of each student
    3/16/08
    N.S.
    (ii) Participating collaboratively in school improvement
    activities and contributing to collegial decision-making.
    3/16/08
    N.S.
    Certification of Initial Plan.
    I certify that, to the best of my
    knowledge, the planned activities
    comply with state laws and regulations.
    Elizabeth Wetzel
    Advisor’s Name
    (Print of Type)
    Elizabeth Wetzel
    Advisor’s Signature
    Western Washington University
    College/University
    1/15/07
    Date of Approval
    Verification by Candidate.
    Under penalty of perjury, I certify
    that, to the best of my knowledge,
    the information on this form is
    accurate.
    Ofelia Miramontes
    Candidate’s Signature
    March 16, 2008
    Date of Verification
    Verification of Completion.
    I certify that I have been this credential
    holder’s advisor, and that, to the best of my
    knowledge, the above information is accurate.
    Sheila Fox
    Advisor’s Name (Print or Type)
    Sheila Fox
    Advisor’s Signature
    Western Washington University
    College/University
    (360) 650-3332
    Workday Telephone Number
    March 23, 2008
    Date of Verification
    Pre-Assessmt Sem. Instructor
    Person who approves
    Portfolio evidence…
    Candidate signs
    when submitting
    portfolio for review
    Instructor signs
    when PGP is
    submitted.
    Program
    Director
    Comes to
    Director
    once
    portfolio
    has been
    approved.

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