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Math Teacher Reference Form
For the Student and Parent
Fill out the form below.
STUDENT AND PARENT WAIVER
THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT OF 1974.
The Math Teacher Reference Form is for admission purposes. As currently interpreted by the Department of Education, the Act provides that applicants who subsequently enroll will have a right to inspect and review the evaluation if it is retained by the Academy, unless that right is waived in writing. Sign your name below only if you wish to waive your right of access.
I request that the Math Teacher Reference Form be sent to St. Johnsbury Academy with the understanding that it will be used for admission purposes.
I understand that I may not read this reference and agree to waive my right of access.
Applicant Signature (Student)
*
Date
*
Date Format: MM slash DD slash YYYY
Parent Signature
*
Date
*
Date Format: MM slash DD slash YYYY
For the Teacher
Fill out the form below.
MATH TEACHER REFERENCE FORM
Your name has been given as a reference by an applicant. The information you provided will be used in the pre-admission process and will not become part of the permanent file. Your assistance is appreciated.
Applicant’s Name
*
Student First Name
Student Last Name
How long have you known this student?
*
In what capacity?
*
Please make the following ratings as realistic as possible, keeping in mind that St. Johnsbury Academy offers a comprehensive curriculum providing remedial through Advanced Placement courses in all academic departments.
Outstanding vocational preparation is also available.
Ability to get along with other students
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Politeness
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Self-discipline
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Maturity
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Study habits and organization
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Energy
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Perseverance under pressure
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Leadership
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Self-confidence
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Sense of humor
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Warmth of personality
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Concern for others
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Reaction to criticism
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Ability
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Motivation
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
As a person
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
As a student
*
Excellent Top 10%
Above Average
Average
Below Average
Poor Bottom 10%
Do you have confidence in the candidate’s integrity?
*
If your confidence is qualified in anyway, please explain.
SUMMARY STATEMENT
*
Please write a summary statement assessing, in as tangible terms as possible, the candidate’s potential for success in a comprehensive boarding school. We are particularly interested in evidence about character, relative maturity, and potential for academic achievement. Refer to both strong and weak points. If the candidate’s record is not a true index of his/her ability, please explain factors that have affected his/her academic achievements.
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*
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*