Request for Teacher Recommendation

Request for Teacher Recommendation

To be completed by Teacher or School Official
Student's Name

First Name Last Name
Academics
Reading Process
Math Process
Writing Process
If below level, please give any interventions that have been tried:
School Day Skills
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:

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

Please complete this form and click submit below.
Should be Empty:

Academics