Confidential Student Reference Form (Upper School)

1 Confidential Student Reference form ( upper school ) We have received an enquiry from the Student named below. Please provide the information requested and send the completed form to admissions office directly. Email: Student s Full Name: Current Year/Grade: Applicant s DOB (dd/mm/yyyy) To the Teacher General Information Your Name: Name of school : International Local Telephone: Email: Relationship to applicant: How long have you known the applicant? Performance (Within the Year Group/Grade) Items No evidence Below expected level At expected level Above expected Excellent Academic ability Use of English - Writing - Speaking - Reading Mathematical ability Academic motivation Study habits/organisational ability Ability to work independently Self- discipline Perseverance Reaction to criticism General behavior Ability to get along with others Politeness Leadership Self- confidence Warmth of personality Sense of humor Maturity Please answer the questions below fully and continue on a separate sheet of paper if necessary.

2 Wherever possible, please provide specific anecdotal support for your views. Also, please include any recommendations you may have on the students placement or curriculum. Please comment on academic ability including any areas of particular strength or weakness and whether the Student currently has any learning support (Is the Student well motivated and capable of independent study?) Strength: Weakness: Please give information about the Student s character and personality. Does he/she relate well to adults and his/her peer group? Please give details of any extra-curricular interests, activities and achievements Art, Music, Drama and Sport. In the case of Music, what grades has the Student achieved? In Sport, what level has the Student achieved?

3 Is there any other information you feel we should have about this applicant? ( EAL/ESL, Emotional, Medical Conditions, Physical)