2019 Summer Scrubs Teacher Recommendation Form
Teacher Recommendation Forms Are Due By March 6, 2019
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.
1. Subject taught/relationship to student *
Your answer
2. How long have you known this student *
Your answer
3. 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
4. Do you recommend this student without hesitation to participate in Summer Scrubs? *
5. Comments:
Your answer
6. 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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