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REFERENCE FORM FOR SCHOOL ADMINISTRATOR/TEACHER
THIS DOCUMENT IS FOR REFERENCES BEING SUBMITTED BY A SCHOOL ADMINISTRATOR OR TEACHER
FULL NAME OF APPLICANT: *
Your answer
CURRENT GRADE LEVEL: *
NAME OF SCHOOL: *
PLEASE LIST THE NAME OF THE SCHOOL THAT YOU ARE WITH
Your answer
SCHOOL ADDRESS: *
Your answer
YOUR HONEST ASSESSMENT OF THE ABOVE NAMED STUDENT IS GREATLY APPRECIATED. ALL INFORMATION WILL BE KEPT CONFIDENTIAL AND WILL NOT BE RELEASED TO ANY THIRD PARTY.
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YOUR NAME: *
Your answer
FOR HOW LONG AND IN WHAT CAPAPCITY HAVE YOU KNOWN THIS STUDENT? *
Your answer
TO YOUR KNOWLEDGE, DOES THE STUDENT HAVE ANY HISTORY OF CONDUCT OR BEHAVIOR PROBLEMS? *
IF "YES" PLEASE EXPLAIN:
Your answer
HOW WOULD YOU DESCRIBE THIS STUDENT? *
(PLEASE NOTE STRENGHTS AND WEAKNESSES. DESCRIBE ATTITUDE IN NEXT QUESTION PLEASE)
Your answer
PLEASE DESCRIBE THE STUDENT'S ATTITUDE TOWARDS SCHOOL, PEERS, AND AUTHORITY: *
Your answer
PLEASE COMMENT ON THE LEVEL OF PARENTAL ENGAGEMENT, INVOLVEMENT, AND SUPPORT (TO BOTH THE STUDENT AND THE SCHOOL) YOU HAVE OBSERVED. *
PLEASE NOTE ANY DIFFICULTIES YOU MAY HAVE EXPERIENCED WITH THE FAMILY
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HOW WOULD YOU, OTHER SCHOOL ADMINISTRATORS, AND TEACHERS FEEL IF THIS STUDENT/FAMILY WERE TO APPLY FOR RE-ADMISSION TO YOUR SCHOOL? *
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PLEASE ADD ANY ADDITIONAL COMMENTS YOU WOULD LIKE TO MAKE ABOUT THIS STUDENT OR FAMILY. THANK YOU FOR YOUR TIME!
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