Request for Teacher Recommendation

Student's Name

First Name Last Name

Reading Process

Math Process

Writing Process

If below level, please give any interventions that have been tried:

Completes work on time

Organizational habits

Personal responsibility

Exhibits self control

Positive interaction with peers

Cooperative worker

Leadership

Amount of extra time required for academic instruction

1

2

3

1 is Low, 3 is High

Amount of extra time required for behavior modification

1

2

3

1 is Low, 3 is High

Level of parent involvement in the classroom & with learning process

1

2

3

1 is Low, 3 is High

If entering K, is this child ready for K?

yes no

Is he/she ready for full day?

yes no

Special medical information on file in the office?

yes no

Is this student on and IEP?

yes no

If yes, what is it for and what accommodations/modifications are made in the classroom?

Special information to next teacher or the office: daily medication, unusual home situation, frequent absences, frequently ill, frequently tardy, separation from another student needed. Explain:

Any additional information you would like to share:

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Name of person completing report: First Name Last Name
Title blank

Do we have permission to contact you to discuss Yes No
Area Code Phone Number

Request for Teacher Recommendation

Academics

School Day Skills

This report is confidential and for administration use to determine acceptance.