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?* Yes No If 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 involved Overly involved Rarely involved No basis for judgment CommentsIf 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*
