MSAD # 11 REACH Teacher/Staff Recommendation Form

Please answer the following text questions with a 1-4 or N/A
1 Characteristic is seldom or never observed
2 Characteristic is occasionally observed
3 Characteristic is frequently observed
4 Characteristic is consistently observed
N/A Not applicable
Student *
Your answer
Date Referred
Your answer
Grade Level
Your answer
Your answer
Staff Submitting Form
Your answer
How many months have you known this child?
Your answer
Student has unusually advanced vocabulary for age or grade level. Verbal behavior is characterized by richness of expression, elaboration, and fluency.
Student possesses a large storehouse of information about a variety of topics or knows a great amount of in-depth information about one subject area
Student has quick mastery and can recall factual information.
Student has a ready grasp of underlying principles and can quickly make valid generalizations about events, people, or things.
Student is a keen and alert observer; usually sees more and gets more out of a story, film, etc. than others.
Student reads a great deal on own; usually prefers older/adult level books, may show a preference for biographies, autobiographies, encyclopedias, and atlases.
Please give specific examples/supporting statements for the above questions. *
Your answer
Student tries to understand complex material by separating it into its respective parts, reasoning things out.
Student becomes absorbed and truly involved in certain topics or problems.
Student easily loses interest in repetitive tasks; often bored with routine tasks and computations.
Student needs little external motivation to follow through with self selected tasks.
Student is self-critical; is not easily satisfied with own speed or products.
Student prefers to work independently.
Student is interested in world problems or issues (politics, hunger, homelessness), and/ or is interested in statistics and data related to problems or issues.
Please give specific examples/supporting statements for the above questions. *
Your answer
Student often is assertive (sometimes even aggressive); persistent in beliefs.
Student is able to organize and bring structure to things, people, and situations; is able to disregard irrelevant data.
Student is quite concerned with right and wrong, good and bad; often evaluates and passes judgment on events, people, and things.
Student approaches matters critically and is unwilling to accept authoritarian pronouncements without critical examination.
Student displays a great deal of curiosity about many things constantly asking questions about anything and everything.
Student generates a large number of ideas or solutions to problems and questions; often offers unusual ("way out"), unique, or clever responses.
Student is uninhibited in expressions of opinion; is sometimes radical and spirited in disagreement; is tenacious.
Please give specific examples/supporting statements for the above questions. *
Your answer
Student is a high risk taker; is adventurous and speculative.
Student displays a good deal of intellectual playfulness: fantasizes, imagines ("I wonder what would happen if?"), manipulates ideas.
Student displays a keen sense of humor and sees humor in situations that may not appear to be humorous to others.
Student shows emotional sensitivity to situations.
Student shows an appreciation of beauty and patterns in nature, art, music, mathematics, etc.
Student is nonconforming; can accept disorder; does not fear being different or solving problems in own way.
Student displays flexibility in thought and/or with materials.
Please give specific examples/supporting statements for the above questions. *
Your answer
Please describe the child’s outstanding ability(ies) and special interests. *
Your answer
In what area(s) does the child need additional challenges or support (this includes affective as well as academic help)? *
Your answer
If this child seems to possess high potential but does not produce in the classroom, please explain: *
Your answer
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