Student's name

Name of reference

Phone number of reference - for any follow up questions

Email of reference - for any follow up questions

Relationship to student (teacher, coach, etc.)

What are this child's overall strengths?

What makes this child unique?

What are some areas of concern, or how does this child deal with challenges?

Social-emotional development compared to typical peers.

Cooperation*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Leadership*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Responsibility*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Kindness*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Inclusiveness of others*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.

Work habits compared to typical peers.

Verbal Skills*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Listening Skills*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Following Direction*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Motivation*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Organization*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Curiosity*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.
Self-regulation*
  • Below average
  • Average
  • Above average
  • Exceptional
  • No elements found. Consider changing the search query.
  • List is empty.

How do the parents of this child support his or her strengths/weaknesses?

Do you have any other comments or concerns about this child's application to The Pelican School?