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Summer Scrubs Teacher Recommendation Form
Teacher recommendation forms are due by March 10, 2017
Student Information
Student Name:
Your answer
School:
Your answer
Student Evaluation
You have been selected as a reference by the above student applying to participate in the Summer Scrubs Program. Your input is very important to us. We are looking for students who are interested in healthcare, will attend the program each day, and are respectful of others. All responses will be kept confidential.
Subject taught/relationship to student
Your answer
How long have you known this student?
Your answer
Please rate the student in the following areas:
Promptness/Attendance
Academic Achievement
Behavior
Responsibility
Eagerness to learn
Cooperation/Attitude
Do you recommend this student without hesitation to participate in Summer Scrubs?
Comments:
Your answer
Teacher Name:
Your answer
Email Address:
Please provide your school email address. No personal email addresses please. We will only contact you should we have additional questions.
Your answer
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