If you are not a current or former science teacher, please state your relationship. For example: "math teacher", "soccer coach", "youth group leader", etc.
Best way to contact you *
Please provide an email address or phone number in case we have any follow-up questions.
Your answer
What opportunities have you had to interact with the student? *
For instance, do you see her daily, weekly, or otherwise? How long have you known her?
Your answer
Having read about the Girls in Science program on our website, do you think this student is a good fit for the program? *
Please explain the reasons for your answer above. *
Your answer
How does this student interact with adults, including yourself? *
Please consider qualities like: Is she reserved or open? Is she willing to speak up? Is she respectful? Is she independent or does she require lots of direction? Is she easy to manage? Does she have a tendency to whine?
Your answer
How does this student interact with her peers? *
Please consider qualities like: Does she make friends easily? Does she include others? Does she listen well? Does she need to be the center of attention? Does she handle conflict appropriately?
Your answer
When I assign group work, I am confident this student will interact well with her classmates. *
Please say how much you agree with the statement above using the scale of 1-5.
Strongly disagree
Strongly agree
When I assign independent work, I am confident this student will stay focused on the task at hand. *
Please say how much you agree with the statement above using the scale of 1-5.
Strongly disagree
Strongly agree
This student understands that in a group setting, her individual needs do not take precedence over the group. *
Please say how much you agree with the statement above using the scale of 1-5.
Strongly disagree
Strongly agree
I can count on this student to behave in an appropriate manner. *
Please say how much you agree with the statement above using the scale of 1-5.
Strongly disagree
Strongly agree
I believe this student has a strong interest in science and nature. *
Please say how much you agree with the statement above using the scale of 1-5.
Strongly disagree
Strongly agree
Imagine you are at the grocery store with your friend or significant other, and you run into this student. After she and her family are out of earshot, what do you say about her to your companion? *
Be honest!
Your answer
Is there anything else we should know about this student to help us decide if she should be accepted to the Girls in Science program?