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We appreciate your cooperation in completing this form. It is one way for us to get to know each child and is reviewed with all of the other information provided with the application. This form will not become part of the student’s permanent record. We value your candid opinion of the applicant. You may be assured that the contents of this report will be kept confidential.
Student's Name
*
First
Last
How long have you known the student?
*
In what grades or subjects have you taught him/her?
*
Please indicate the outstanding attributes of this student in a few words or adjectives.
*
To your knowledge, has the student had either serious or minor but sustained, discipline issues at school?
*
Yes
No
If yes, briefly explain
In your experience, is the parent’s perception of the student compatible with the school’s understanding of the student?
*
Please describe the parent’s involvement in school activities.
*
Appropriately involved
Overly involved
Rarely involved
No basis for judgment
Comments
If you are aware of any family circumstances that affect the student’s life at home/school please describe?
What kind of support might the student need from our school to reach his or her potential?
Is there any additional information that can be better conveyed in a phone conversation?
*
Yes
No
Best times to call are:
Please rate the applicant in the following areas:
Academic Qualities
Academic potential
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Academic achievement
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Effort/motivation
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Study habits
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Ability to work in a group
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Ability to work independently
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Ability to communicate ideas
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Homework
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Intellectual curiosity
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Completion of tasks
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Willingness to ask for help
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Ability to follow directions
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Attention span
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Organization
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
English Skills
Reading skill
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Written expression
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Oral expression
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Math Skills
Computation accuracy
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Conceptual understanding
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Personal Qualities
Respect for others
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Self-confidence
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Sense of humor
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Creativity
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Peer interaction
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Leadership potential
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Maturity for age
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Attendance
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Integrity
*
No Basis For Judgment
Weak
Fair
Good
Excellent
Exceptional
Use the comment box below to explain any strengths or weaknesses.
*
I recommend this student:
*
Enthusiastically
Confidently
With reservation
Do not recommend
Teacher's Name
*
First
Last
Subject
Email
*
Phone
*
School Name
*
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Dec
16
December 16
-
December 20
High School Finals Week
Dec
19
All day
Lunch: Cream of Spinach Soup & Grilled Cheese
Dec
19
3:30 pm
-
5:00 pm
Practice: HS Boys Basketball
Dec
19
3:30 pm
-
5:00 pm
Practice: MS Boys Basketball
Dec
19
3:30 pm
-
5:00 pm
Cancelled Practice: HS Soccer
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