Preschool/Kindergarten Confidential Report 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?*YesNoIf yes, briefly explainIn 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 involvedOverly involvedRarely involvedNo basis for judgmentCommentsIf 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?*YesNoBest times to call are:Please rate the applicant in the following areas:Shows curiosity and interest in his/her surroundings*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkInitiates own play activities*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkWorks and plays cooperatively with other children*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkHas capacity to lead*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkTalks comfortably with other children*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkTakes turns and shares*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkParticipates with others in large groups*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkShows concern for others and their property*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkCan use age-appropriate conflict resolution strategies*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkDoes simple tasks independently*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkFollows directions*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkPays attention*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkConsistently completes tasks*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkCan stay on task for at least 10 minutes*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkIs eager to learn new tasks*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkAble to express wants and needs*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkUses materials purposefully*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkFeels good about self*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkAccepts limits/Follows rules*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkAccepts responsibility*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkDisplays feeling in appropriate ways*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkSeparates from parents without reluctance*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkSpeech understood by others*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkCan dress independently*No Basis For JudgmentSecureDevelopingBeginningNeeds WorkUse the comment box below to explain any strengths or weaknesses.*I recommend this student:*EnthusiasticallyConfidentlyWith reservationDo not recommendTeacher's Name* First Last Email* Phone*School Name*
