Middle/High School 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:Academic QualitiesAcademic potential*No Basis For JudgmentWeakFairGoodExcellentExceptionalAcademic achievement*No Basis For JudgmentWeakFairGoodExcellentExceptionalEffort/motivation*No Basis For JudgmentWeakFairGoodExcellentExceptionalStudy habits*No Basis For JudgmentWeakFairGoodExcellentExceptionalAbility to work in a group*No Basis For JudgmentWeakFairGoodExcellentExceptionalAbility to work independently*No Basis For JudgmentWeakFairGoodExcellentExceptionalAbility to communicate ideas*No Basis For JudgmentWeakFairGoodExcellentExceptionalHomework*No Basis For JudgmentWeakFairGoodExcellentExceptionalIntellectual curiosity*No Basis For JudgmentWeakFairGoodExcellentExceptionalCompletion of tasks*No Basis For JudgmentWeakFairGoodExcellentExceptionalWillingness to ask for help*No Basis For JudgmentWeakFairGoodExcellentExceptionalAbility to follow directions*No Basis For JudgmentWeakFairGoodExcellentExceptionalAttention span*No Basis For JudgmentWeakFairGoodExcellentExceptionalOrganization*No Basis For JudgmentWeakFairGoodExcellentExceptionalEnglish SkillsReading skill*No Basis For JudgmentWeakFairGoodExcellentExceptionalWritten expression*No Basis For JudgmentWeakFairGoodExcellentExceptionalOral expression*No Basis For JudgmentWeakFairGoodExcellentExceptionalMath SkillsComputation accuracy*No Basis For JudgmentWeakFairGoodExcellentExceptionalConceptual understanding*No Basis For JudgmentWeakFairGoodExcellentExceptionalPersonal QualitiesRespect for others*No Basis For JudgmentWeakFairGoodExcellentExceptionalSelf-confidence*No Basis For JudgmentWeakFairGoodExcellentExceptionalSense of humor*No Basis For JudgmentWeakFairGoodExcellentExceptionalCreativity*No Basis For JudgmentWeakFairGoodExcellentExceptionalPeer interaction*No Basis For JudgmentWeakFairGoodExcellentExceptionalLeadership potential*No Basis For JudgmentWeakFairGoodExcellentExceptionalMaturity for age*No Basis For JudgmentWeakFairGoodExcellentExceptionalAttendance*No Basis For JudgmentWeakFairGoodExcellentExceptionalIntegrity*No Basis For JudgmentWeakFairGoodExcellentExceptionalUse the comment box below to explain any strengths or weaknesses.*I recommend this student:*EnthusiasticallyConfidentlyWith reservationDo not recommendTeacher's Name* First Last SubjectEmail* Phone*School Name*
