EmailMe Form - Second through Fifth Grade Academic Reference

We appreciate your cooperation in completing this form. It provides a lens to gather insight about the candidate, fully understanding that children are constantly changing and developing. We place particular value on your observations of classroom behavior and your descriptive comments. All information you provide will be kept strictly confidential. Thank you for your time.

Academy Hill enrolls students who are academically able and willing to challenge themselves, and who will add to our respectful and caring community. We appreciate your honest evaluation.

Student Name: *

What are the first words that come to mind to describe this candidate? *

Sense of Responsibility *

Area of Strength

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Area of Concern

Descriptive Comments:

Consideration for Others *

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Area of Concern

Descriptive Comments:

Social Relationships with Peers *

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Leadership Ability *

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Emotional Maturity *

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Self-Confidence *

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Area of Concern

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Sense of Humor *

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Self-Control *

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Relationship with Adults *

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Descriptive Comments

We appreciate comments and observations concerning the strengths, weaknesses or any special needs/concerns of this student and family.

Study Habits *

Motivation *

Organization of Time and Work *

Curiosity *

Attention Span *

Ability to Express Ideas Orally *

Ability to Work in a Group *

Creativity *

Reading for Pleasure *

Attendance Pattern *

Parent/Guardian Cooperation and Involvement *

Your Name *

First Last

Date *

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Phone *

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School Name *

First Last

School Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

I have known this child for *

My relationship has been that of *