Confidential Teacher Recommendation Form

Confidential Teacher Recommendation Form
TO THE TEACHER: This recommendation will remain confidential and will not become part of the student’s permanent academic
record.We sincerely appreciate your cooperation and candor as you provide us with necessary information to make informed
admissions decisions for young children.
Student Information
Student Name*

First NameMiddle NameLast Name
Candidate for Grade*
Days child attends each week

MondayTuesdayWednesdayThursdayFriday
Timing

1/2 DayFull DayExtended Care
Student Assessment

Compared to all the students this age that you have taught, please check the most appropriate response for this child
1. Attention Span

Focuses and maintains attention overtimeAttends with occasional teacher redirectionEasily distracted by noise or movement of othersand requires frequent redirection
2. Task Persistence

Persists and completes tasks independentlyAttempts task, with some encouragementAttempts task, after much encouragementRefuses to attempt/complete task
3. Degree of Independence

Able to work on most tasks independentlyRequires occasional assistance to complete taskRequires frequent assistance to complete taskNeeds constant supervision/guidance to complete task
4. Peer Relationships

Works and/or plays well with othersFriendly, but reservedHas difficulty interacting with peers
5. Attention to Directions in Teacher Directed Activities

Listens carefully to entire directionsAttends only to brief directionsPlunges ahead after hearing only portion of Directions
6. Comprehension of Directions in Teacher DirectedActivities

Rapid comprehension of most directions, given age expectationsUnderstands after several repetitionsAfter several repetitions, understands only partial directionsDoes not appear to comprehend most directions
7. Verbalization

Speaks clearly and confidentlyCommunicates ideas clearlyHas difficulty expressing wants/needsSpeech has sound substitutionsUnable to communicate clearly
8. Body Movement at Listening Times

Sits quietlySome squirmingMuch movementOut of seat; body constantly in motion
9. Response to Stress/Pressure

Withdraws socially or emotionallyReacts physicallyReacts verballyAdapts slowlyCopes well
10. Confidence

Very sure of selfConfident with things known, attempts new things with encouragementReluctant to try new or difficult things
11. When conflict arises, this person generally responds with:

Defensive/Critical attitudeWithdrawal/AvoidanceLack of cooperationConfrontationOpenness to resolving conflictPeacemakingVery uncertain; needs much encouragement
Self Help Skills
Can dress self

Age AppropriateNeeds Development
Uses toilet unassisted

Age AppropriateNeeds Development
Physical Development
Small motor muscle control and coordination

Age AppropriateNeeds Development
Large motor muscle control and coordination

Age AppropriateNeeds Development
Additional Information
Please comment on the individual strengths of this student:
Are there activities that appear difficult for this student:
Please comment on this student’s emotional and social maturity:
Please comment on the likelihood of this student being successful in a challenging program:
Has this family been a supportive partner with the classroom teacher and school?:
Has the applicant’s home environment been a positive force in his/her development? Please explain:
Do you have any questions or reservations about this student you would like to discuss with us?
If this student were to reapply to your school, would you grant acceptance?
Please check applicable: (please refer to the appropriate party for the following information)

Parents/Guardians meet financial obligations.Parents/Guardians have difficulty meeting financial obligations.Parents/Guardians fail to meet financial obligations.Parents/Guardians support school sponsored activities.Parents/Guardians do not support school-sponsored activities.
Form Completed by:
Full Name*

PrefixFirst NameLast Name
School Name*
Contact Phone Number*
Signature*

Clear
Phone Number (Where you may be reached during the day)
Holy Angels Elementary School

360 Campus Dr, Arcadia, CA 91007
Phone: (626) 447-6312
Should be Empty:

Confidential Teacher Recommendation Form

Student Information

Student Assessment

Self Help Skills

Physical Development

Additional Information

Form Completed by: