Please enable JavaScript in your browser to complete this form.Student's Name *FirstLastCurrent GradeFrom when to when (dates) did you teach this student? Where did you teach this student? What subjects or in what capacity did you teach this student? Does this student have a teachable attitude? AlwaysUsuallySometimesSeldomNot ApplicableDoes this student pay attention in class? AlwaysUsuallySometimesSeldomNot ApplicableDoes this student complete assignments in a timely manner?AlwaysUsuallySometimesSeldomNot ApplicableDoes this student put forth good effort on assignments?AlwaysUsuallySometimesSeldomNot ApplicableDoes this student contribute positively to discussions? AlwaysUsuallySometimesSeldomNot ApplicableDoes this student respond appropriately to authority and discipline? AlwaysUsuallySometimesSeldomNot ApplicableDoes this student respect classroom rules and standards? AlwaysUsuallySometimesSeldomNot ApplicableDoes this student have a good attendance record? AlwaysUsuallySometimesSeldomNot ApplicableDoes this student work well with others? AlwaysUsuallySometimesSeldomNot ApplicablePlease describe the applicant’s influence in your class.What academic concerns, if any, do you have regarding the applicant?What social or disciplinary concerns, if any, do you have regarding the applicant?From a teacher’s perspective, does the applicant receive proper academic and disciplinary support from his/her parents?Describe how the applicant interacts with his/her peers within the school setting.What level of academic success would you anticipate for this applicant?Highest AchievementAverage AchievementLow AchievementWhat is your name and position? May we contact you with further questions? YesNoIf yes, what is your preferred method of contact? Be assured your comments will be kept confidential. Thank you for your time and assistance. Submit
