SACRED HEART SCHOOL, COVINA
CONFIDENTIAL TEACHER RECOMMENDATION FORM
FOR KINDERGARTEN APPLICANTS ONLY
TO THE PARENT: As part of the admissions process at Sacred Heart School we must receive a candid assessment of the applicant. The student’s application will not be processed without this completed form. Please fill in the following information and give this form to your student’s teacher. He or she will appreciate being given plenty of time to complete this form as well as an addressed and stamped envelope in which to mail it directly to Sacred Heart School to the attention of the principal. A copy of your child’s most recent report card and Standardized Test results is to be included with this form. Failure to complete file by March 12, 2010 will result in your child losing priority admission status.
NAME OF APPLICANT:
First Middle Last
Candidate for Kindergarten in September, 2010.
School: Sacred Heart School 360 W. Workman St.. Covina, CA 91723
TO THE TEACHER: This recommendation will remain confidential and will not become part of the student’s permanent academic record. We sincerely appreciate your cooperation and candor as you provide us with necessary information to make informed admissions decisions for young children. Please return this form, along with the applicant’s most recent report card (if applicable) to the attention of the Principal, Sacred Heart School, as soon as possible.
Days child attends each week: □ M □ T □ W □ Th □ F □ ½ Day □ Full Day □ Extended Care
Compared to all the students at this age that you have taught, please check the most appropriate response for this child.
1. Attention Span
□ Focuses and maintains attention over time
□ Attends with occasional teacher redirection
□ Easily distracted by noise or movement of
others and requires frequent redirection
2. Task Persistence
□ Persists and completes tasks independently
□ Attempts task, with some encouragement
□ Attempts task, after much encouragement
□ Refuses to attempt/complete task
3. Degree of Independence
□ Able to work on most tasks independently
□ Requires occasional assistance to complete task
□ Requires frequent assistance to complete task
□ Needs constant supervision/guidance to complete
task
4. Peer Relationships
□ Works and/or plays well with others
□ Friendly, but reserved
□ Has difficulty interacting with peers
5. Attention to Directions in Teacher Directed Activities
□ Listens carefully to entire directions
□ Attends only to brief directions
□ Plunges ahead after hearing only portion of
directions
6. Comprehension of Directions in Teacher Directed
Activities
□ Rapid comprehension of most directions, given
age expectations
□ Understands after several repetitions
□ After several repetitions, understands only
partial directions
□ Does not appear to comprehend most
directions
7. Verbalization
□ Speaks clearly and confidently
□ Communicates ideas clearly
□ Has difficulty expressing wants/needs
□ Unable to communicate clearly
□ Speech has sound substitutions
8. Body Movement at Listening Times
□ Sits quietly
□ Some squirming
□ Much movement
□ Out of seat; body constantly in motion
9. Response to Stress/Pressure
□ Withdraws socially or emotionally
□ Reacts physically
□ React verbally
□ Adapts slowly
□ Copes well
10. Confidence
□ Very sure of self
□ Confident with things known, attempts new things
without encouragement
□ Reluctant to try new or difficult things
□ Very uncertain; needs much encouragement
11. When conflict arises, this child generally responds
with:
□ Defensive/Critical attitude
□ Withdrawal/Avoidance
□ Lack of cooperation
□ Confrontation
□ Openness to resolving conflict
□ Peacemaking
Self Help Skills
Can dress self □ Age Appropriate □ Needs Development
Uses toilet unassisted □ Age Appropriate □ Needs Development
Physical Development
Small motor muscle control and coordination □ Age Appropriate □ Needs Development
Large motor muscle control and coordination □ Age Appropriate □ Needs Development
Please comment on the individual strengths of this student:
Are there activities that appear difficult for this student:
Please comment on this student’s emotional and social maturity:
Please comment on the likelihood of this student being successful in a challenging program:
Has this family been a supportive partner with the classroom teacher and school?:
Has the applicant’s home environment been a positive force in his/her development? Please explain:
Do you have any questions or reservations about this student you would like to discuss with us?
If this student were to reapply to your school, would you grant acceptance?
Please check two of the following, if applicable:
(please refer to the appropriate party for the following information)
Parents/Guardians meet financial obligations.
Parents/Guardians have difficulty meeting financial obligations.
Parents/Guardians fail to meet financial obligations.
Parents/Guardians support school sponsored activities.
Parents/Guardians do not support school-sponsored activities.
Form completed by:
Name (please print) Title School Name
Signature:
Telephone Number:
(Where you may be reached during the day)
This form is to be mailed directly to:
Principal
Sacred Heart School
360 W. Workman St.
Covina, CA 91723
It may also be faxed to the Principal at (626)967-8836