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Signed, __________________ __________________ __________________ Print Name Print Name Print Name __________________ __________________ __________________ Signature Signature Signature __________________ __________________ __________________ Print Name Print Name Print Name __________________ __________________ __________________ Signature Signature Signature Lakeville Area Public Schools • PLC Handbook • Page 35 modified 11/15/2010
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Appendix D: PLC Administrator Form Lakeville Area Public Schools • PLC Handbook • Page 36 modified 11/15/2010
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Appendix E: Sample Midyear PLC Survey Midyear PLC Survey This survey is intended to help the school learn more about they type of work that has occurred in PLC teams so far this year and how to best plan the PLC time for the remainder of the year. The survey is divided into two sections: the ways in which your team has managed PLC meetings and the types of tasks on which your team has focused. Thank you for completing this survey in an honest and thoughtful manner. Your grade level of course area: _____________________________________________ Please indicate the extent to which each of the statements below is true by circling one of the four numbers using the following scale: 1 = Very true 2 = True 3 = Somewhat true 4 = Not true We have an agreed‐upon set of meeting norms in our PLC team (for example, expectations for participant behaviors during meetings). 1 2 3 4 We follow our meeting norms consistently at PLC meetings. 1 2 3 4 Our norms help us to have productive, effective conversations. 1 2 3 4 We have clear tasks to perform at our PLC meetings. 1 2 3 4 Our tasks relate directly to student learning goals. 1 2 3 4 Our tasks are determined by consensus among our team members. 1 2 3 4 A large majority of our PLC time (80 percent or more) is spent on tasks related to student learning goals. 1 2 3 4 During PLC conversations, team members sometimes disagree about ideas or practices. 1 2 3 4 When team members disagree about ideas or practices, we tend to discuss those disagreements in depth. 1 2 3 4 When I disagree with something a member of my PLC has said, I almost always voice that disagreement. 1 2 3 4 Within PLC meetings, we try to avoid emotionally charged or difIicult topics or conversations. 1 2 3 4 I feel a strong sense of attachment to my team. 1 2 3 4 If we were given the option of no longer meeting as a PLC, I would still want to continue the meetings. 1 2 3 4 I have improved as a classroom teacher as a result of the conversations and work we have done in our PLC. 1 2 3 4 I have made changes to my teaching practices as a result of the work that we have done as a PLC. 1 2 3 4 Lakeville Area Public Schools • PLC Handbook • Page 37 modified 11/15/2010
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Team Based Collaboration: Teaching and Learning Tasks Please indicate the extent to which each of the statements below is true by circling one of the four numbers using the following scale: 1 = Very true 2 = True 3 = Somewhat true 4 = Not true My PLC team has worked to deIine the most important student learning goals in our content areas.
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