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?* 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:Academic QualitiesAcademic potential* No Basis For Judgment Weak Fair Good Excellent Exceptional Academic achievement* No Basis For Judgment Weak Fair Good Excellent Exceptional Effort/motivation* No Basis For Judgment Weak Fair Good Excellent Exceptional Study habits* No Basis For Judgment Weak Fair Good Excellent Exceptional Ability to work in a group* No Basis For Judgment Weak Fair Good Excellent Exceptional Ability to work independently* No Basis For Judgment Weak Fair Good Excellent Exceptional Ability to communicate ideas* No Basis For Judgment Weak Fair Good Excellent Exceptional Homework* No Basis For Judgment Weak Fair Good Excellent Exceptional Intellectual curiosity* No Basis For Judgment Weak Fair Good Excellent Exceptional Completion of tasks* No Basis For Judgment Weak Fair Good Excellent Exceptional Willingness to ask for help* No Basis For Judgment Weak Fair Good Excellent Exceptional Ability to follow directions* No Basis For Judgment Weak Fair Good Excellent Exceptional Attention span* No Basis For Judgment Weak Fair Good Excellent Exceptional Organization* No Basis For Judgment Weak Fair Good Excellent Exceptional English SkillsReading skill* No Basis For Judgment Weak Fair Good Excellent Exceptional Written expression* No Basis For Judgment Weak Fair Good Excellent Exceptional Oral expression* No Basis For Judgment Weak Fair Good Excellent Exceptional Math SkillsComputation accuracy* No Basis For Judgment Weak Fair Good Excellent Exceptional Conceptual understanding* No Basis For Judgment Weak Fair Good Excellent Exceptional Personal QualitiesRespect for others* No Basis For Judgment Weak Fair Good Excellent Exceptional Self-confidence* No Basis For Judgment Weak Fair Good Excellent Exceptional Sense of humor* No Basis For Judgment Weak Fair Good Excellent Exceptional Creativity* No Basis For Judgment Weak Fair Good Excellent Exceptional Peer interaction* No Basis For Judgment Weak Fair Good Excellent Exceptional Leadership potential* No Basis For Judgment Weak Fair Good Excellent Exceptional Maturity for age* No Basis For Judgment Weak Fair Good Excellent Exceptional Attendance* No Basis For Judgment Weak Fair Good Excellent Exceptional Integrity* No Basis For Judgment Weak Fair Good Excellent Exceptional 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 Subject Email* Phone*School Name*
