Family Pastoral Reference

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.Format: (000) 000-0000.

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

Works independently with focus

Approaches assignments in creative or novel ways

Completes classwork and homework on time

Listens to and follows directions

Seeks to deepen understanding

Effectively communicates ideas

Synthesizes information

Works from internal motivation

Leads and follows appropriately

Is aware of his/her own strengths and contributions

Works cooperatively

Approaches school and relationships with honesty and integrity

Takes responsibility for her/his own actions

Works to resolve conflicts with peers

Regulates impulses and emotions

Accepts criticism appropriately

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.

Teacher Reference Form