Teacher - Please complete this confidential form.  This information will be treated confidentially and will not be shared with parents.  You will receive an electronic copy for your files upon submission via the email address provided.  Thank you for your cooperation and honesty.  The student's application cannot be processed until this form is received by our Admissions Office.

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* 1. Enter the student's full name

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* 2. Enter the grade or subject area you taught them.

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* 3. Overall, is this student in good standing and eligible to re-enter your school whether or not you offer the next grade level?

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* 4. Please enter your teacher and school information below.

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* 5. I would be willing willing to discuss this applicant by telephone

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* 6. Social Skills Ratings

  Exceeds Expectations Area of Strength Age Appropriate Progressing Area of Concern
Self-esteem
Acceptance of limits
Self-motivation
Ability to work independently
Interaction with peers
Interaction with teachers
Uses words to express feelings
Internalization of classroom routine

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* 7. Social Skills Ratings

  Exceeds Expectations Area of Strength Age Appropriate Progressing Area of Concern
Separation from parents/caregivers
Ability to share and work cooperatively
Ability to wait turn
Respect for property (personal and others)
Accepts responsibility for actions
Sense of humor
Curiosity/imagination
Attention span: self-chosen activity

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* 8. Social Skills Ratings

  Exceeds Expectations Area of Strength Age Appropriate Progressing Area of Concern
Attention span: assigned activity
Cooperative attitude
Leadership skills
Makes transitions easily
Ability to focus in large group
Ability to focus in small group
Responds to redirection

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* 9. Usually chooses to work in:

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* 10. Usually takes role of:

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* 11. Hand dominance:

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* 12. Physical Development Ratings

  Exceeds Expectations Area of Strength Age Appropriate Progressing Area of Concern
Fine motor coordination
Draws with details
Uses appropriate pencil grip
Gross motor coordination
Body/space awareness
Balance, gait, fluidity, smoothness of movement
Participate in physical group activity

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* 13. Please describe any notable social or emotional strengths or weaknesses.  What steps have been taken to address the areas of concern?

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* 14. Please note any physical, visual and/or auditory strengths or weaknesses:

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* 15. Check all the words that best describe this applicant:

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* 16. Please add any additional information that would provide a more complete picture of the student and family. (optional)

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* 17. This applicant/family is habitually tardy or late:

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* 18. Parent Support:

  Consistently Usually Seldom Not Observed
Parent(s) participate in school activities
Parent(s) support school policies and procedures

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* 19. This applicant/student is:

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