Teacher/school official: provide your personal information below and complete the reference. This reference will remain confidential and will not become part of the applicant’s permanent record. Thank you for your time and effort.

Reference Information

Applicant Name: *

Name of Academic Reference: *

your name

Position:

your job title (include grades/subjects taught)

Name of School/Institution:

School address:

School phone: *

Your School Email: *

Required so that a Bethany Christian School's official can contact you to verify the authenticity of this submission.

Applicant Information

Evaluate this applicant on the following characteristics by checking the appropriate box:

Gets along with peers:

Unknown

Low

Average

High

Respects others' rights and property:

Unknown

Low

Average

High

Enters new activities enthusiastically:

Unknown

Low

Average

High

Cooperates with classmates and teachers:

Unknown

Low

Average

High

Is dependable:

Unknown

Low

Average

High

Listens attentively:

Unknown

Low

Average

High

Follows directions:

Unknown

Low

Average

High

Accepts and follows suggestions for improvement:

Unknown

Low

Average

High

Shows leadership qualities:

Unknown

Low

Average

High

Participates in class discussions:

Unknown

Low

Average

High

Works independently:

Unknown

Low

Average

High

Demonstrates self-confidence/positive self-image:

Unknown

Low

Average

High

Exhibits self-control in the classroom:

Unknown

Low

Average

High

Follows rules:

Unknown

Low

Average

High

Accepts responsibility for own actions:

Unknown

Low

Average

High

Uses time wisely:

Unknown

Low

Average

High

Completes class work in reasonable time:

Unknown

Low

Average

High

Completes homework assignments:

Unknown

Low

Average

High

Is enthusiastic about learning:

Unknown

Low

Average

High

Organizes and plans well:

Unknown

Low

Average

High

Understands concepts/materials:

Unknown

Low

Average

High

Uses classroom materials responsibly:

Unknown

Low

Average

High

What are this student's strengths?:

In what areas does this student need to improve?:

What are the first three words that come to your mind to describe this student?:

Please offer additional comments that would be helpful to school personnel as they work with this student at Bethany.:

Thank you for your time, honesty, and insight

Is there information about this student that would be better communicated by telephone?:

Yes

No

Verification: *

I affirm that all information contained herein is accurate to the best of my knowledge and that I am the Academic Reference named above.