2020 Summer Scrubs Teacher Recommendation Form
Teacher Recommendation Forms are due by March 6, 2020
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 the student? *
Your answer
Please rate the student in the following areas: mark only one oval *
Excellent
Above Average
Average
Fair
Poor
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. Please no personal email addresses please. We will only contact you should we have any additional questions. *
Your answer
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