Student Recommendation Form

Date*

MM/DD/YYYY

Student Name*

School that Student Currently Attends*

Name of Evaluator*

Evaluator's Title*

Evaluator's Phone Number* - -

Evaluator's Email*

How long have you known the student?*

In what capacity do you know the student?*

Does this student have any circumstances known to you that could affect his/her placement in a college preparatory program (i.e, emotional or learning*

Please explain*

Does this student have a 504 Plan or IEP?*

Academic Achievement*Very GoodGoodAveragePoorVery PoorN/A

Academic Potential*Very GoodGoodAveragePoorVery PoorN/A

Character*Very GoodGoodAveragePoorVery PoorN/A

Integrity*Very GoodGoodAveragePoorVery PoorN/A

Responsibility*Very GoodGoodAveragePoorVery PoorN/A

Leadership*Very GoodGoodAveragePoorVery PoorN/A

Motivation*Very GoodGoodAveragePoorVery PoorN/A

Initiative*Very GoodGoodAveragePoorVery PoorN/A

Concern for Others*Very GoodGoodAveragePoorVery PoorN/A

Based on your interaction with this student, please comment on the student's qualifications:*

Related to the characteristics listed above, as well as interests and activities in-school and out-of-school.

Summary Evaluation*Highly RecommendRecommendRecommend with ReservationDo Not Recommend

Overall Recommendation

Signature*

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Student Recommendation Form

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