* Required

Date (mm/dd/yyyy)

Name of Student

Name of School

School Address

Thank you for taking the time to complete this evaluation. Your expertise and insight are invaluable to us as we gather information about each applicant.

Please rate the following as:

S = Significant strength

A = Average

G = Guidance needed

Personal Characteristics / Study Habits

Student motivation

Is self-directed

Concentrates on chosen task

Relates well to peers

Exhibits self-discipline in groups

Completes work within given time-frame

Organizational skills

Attitude toward others

Creativity

Maturity related to age

Ability to work independently

Ability to work in a group

Academic Performance - Lauguage

Oral language skills

Reading fluency

Reading comprehension

Writing skills

Academic Performance - Mathematics

Math facts / computation

Problem-solving skills

Math concepts

Areas in which student excels

Areas in which student needs assistance

Do parents have clear perception of student's abilities?

Are there any aspects of the applicant's family life or physical or emotional history of which we should be aware?

How long and in what capacity have you know the applicant?

Additional comments

Teacher's name

Date (mm/dd/yyyy)