Breakthrough Optional Teacher Rec.
Student First Name *
Your answer
Student Last Name *
Your answer
Student School *
Your answer
Recommender First and Last Name *
Your answer
What are the First 3 words that come to mind when you think of this student? *
Your answer
In your opinion, what is this student's greatest strength and challenge? *
Your answer
Is there anything we should know about the child's academic skills, family issues, social behavior, in specific? (Feel free to email additional info
Your answer
Please select the response that best suits the student in relation to the other students you teach/work with. *
Below Average 1
Average 2
Above Average 3
Outstanding 4
Skill Level (General)
Motivation and Effort
Overall Assessment
Given what you know of this student's parent(s)/guardian(s) please check the appropriate statements below. *
Not Observed
Communicate about student's progress
Support school policies and procedures
Breakthrough is a program for hardworking, dedicated and motivated students who want to go to college. I recommend this student: *
Electronic Signature *
Your answer
Email Address (For potential follow up) *
Your answer
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