Family Pastoral Reference

Teacher Reference Form
Recognizing that completing this form is not part of your official duties, our school greatly appreciates your helping the applicant by supplying the information requested. Please note that the information you submit will be confidential, will not be shared with the student and family, and will not become part of the student’s permanent school records.
Student's Name*

First NameLast Name
Current School*
Current Grade*
Person Completing this Form*

First NameLast Name
Email*
example@example.com
School*
Subject(s)*
Grade Level*
Phone Number
Please enter a valid phone number.
How long have you known the student and in what capacity?*
What are the first few words that come to mind to describe the student?*
Please rate the student in the following academic and behavioral qualities:
Comes to class prepared*

consistentlyusuallysometimesrarelynever
Works independently with focus*

consistentlyusuallysometimesrarelynever
Approaches assignments in creative or novel ways*

consistentlyusuallysometimesrarelynever
Completes classwork and homework on time*

consistentlyusuallysometimesrarelynever
Listens to and follows directions*

consistentlyusuallysometimesrarelynever
Seeks to deepen understanding*

consistentlyusuallysometimesrarelynever
Effectively communicates ideas*

consistentlyusuallysometimesrarelynever
Synthesizes information*

consistentlyusuallysometimesrarelynever
Works from internal motivation*

consistentlyusuallysometimesrarelynever
Leads and follows appropriately*

consistentlyusuallysometimesrarelynever
Is aware of his/her own strengths and contributions*

consistentlyusuallysometimesrarelynever
Works cooperatively*

consistentlyusuallysometimesrarelynever
Approaches school and relationships with honesty and integrity*

consistentlyusuallysometimesrarelynever
Takes responsibility for her/his own actions*

consistentlyusuallysometimesrarelynever
Works to resolve conflicts with peers*

consistentlyusuallysometimesrarelynever
Regulates impulses and emotions*

consistentlyusuallysometimesrarelynever
Accepts criticism appropriately*

consistentlyusuallysometimesrarelynever
Please comment upon the applicant's academic and personal strengths*
Please comment upon the applicant's academic and personal weaknesses*
Are the parents of this applicant supportive of their child’s strengths and challenges? Have their expectations and perceptions of their child and your program been in alignment with yours and your school’s?*
Please mention any additional information which you think might help our school make an informed decision.*
If the school needs clarification, may we contact you by phone or by email.*

YesNo
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Teacher Reference Form