Parental Authorization for Confidential Report (Elementary)

Please fill out the following information and your child’s current teacher will be sent a form to complete. Fill out the form once for each teacher from whom you are requesting a report.

Alternatively, you may print and send confidential reports to previous teachers.

For Elementary, we request two confidential reports, one to be completed by the child’s current teacher and the other by another academic or extracurricular teacher who knows your child well.

Applying for Grade:*
Student's Name*
First Middle Last
Teacher Name*
First Last
Teacher Email*
School*
Parent Name*
First Last
Parent Signature*
I consent to the confidential report request.
I waive my right to access this Confidential Report submitted on my behalf and authorize Mount Madonna School to contact my child's current and previous schools for information regarding my child. All information received by the Admissions Office will be kept confidential by the Admissions Committee.