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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:
Shows curiosity and interest in his/her surroundings
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Initiates own play activities
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Works and plays cooperatively with other children
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Has capacity to lead
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Talks comfortably with other children
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Takes turns and shares
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Participates with others in large groups
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Shows concern for others and their property
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Can use age-appropriate conflict resolution strategies
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Does simple tasks independently
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Follows directions
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Pays attention
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Consistently completes tasks
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Can stay on task for at least 10 minutes
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Is eager to learn new tasks
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Able to express wants and needs
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Uses materials purposefully
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Feels good about self
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Accepts limits/Follows rules
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Accepts responsibility
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Displays feeling in appropriate ways
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Separates from parents without reluctance
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Speech understood by others
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
Can dress independently
*
No Basis For Judgment
Secure
Developing
Beginning
Needs Work
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
Email
*
Phone
*
School Name
*
Jul
29
All day
Event Series
Mountain of Fun Summer Camp: Nature Explorers, ages 3-5
Jul
29
July 29
-
August 2
Mountain of Fun Summer Camp: Mountain Explorers, ages 6-9
Jul
30
All day
Event Series
Mountain of Fun Summer Camp: Nature Explorers, ages 3-5
Jul
31
All day
Event Series
Mountain of Fun Summer Camp: Nature Explorers, ages 3-5
Aug
1
All day
Event Series
Mountain of Fun Summer Camp: Nature Explorers, ages 3-5
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