EmailMe Form - First Grade Teacher Referral

To the Teacher:

We appreciate your cooperation in completing this form. It will be used, along with other items of assessment, to determine readiness
for first grade. This form gives us the opportunity to get to know the child with the full understanding that young children are constantly changing
and maturing. Please circle the applicable numbers below. We also welcome your comments in each area. We also appreciate your promptness in
returning this form as there are admissions deadlines approaching.

Please note that this referral MUST come from the teacher's email address (and not the parents).

Student's Name *

First Last

Student's Current School *

School's Phone

### - ### - ####

Name of Teacher Completing this form *

First Last

Teacher's Email (in case we have further questions)

For how long have you known this applicant? *

What words immediately come to mind concerning this student: *

What words immediately come to mind concerning this family’s cooperation and involvement with school? *

Physical Development

Please circle the numbers that best represent the student. We welcome your comments.

Small muscle/coordination *

Additional Comments

Holds pencil properly *

Additional Comments

Prints name using upper/lower case *

Additional Comments

Prints alphabet correctly *

Additional Comments

Large muscle control/coordination *

Additional Comments

Speech development (articulation) *

Additional Comments

Reading Readiness

Please circle the numbers that best represent the student. We welcome your comments.

Reads Basic Sight Words *

Additional Comments

Is able to identify and name upper
case letters *

Additional Comments

Is able to identify and name lower
case letters *

Additional Comments

Associates sounds with letters *

Additional Comments

Indentifies vowel sounds in words *

Additional Comments

Able to read “cvc” and “cvcv”
words *

Additional Comments

Shows interest in books and stories *

Additional Comments

Comprehends what is read *

Additional Comments

Beginning Math Skills

Accurately counts groups of objects *

Additional Comments

Identifies numerals to 21 *

Additional Comments

Understands concept of addition *

Additional Comments

Understands concept of subtraction *

Additional Comments

SOCIAL DEVELOPMENT/WORK
HABITS

Is courteous/considerate of others *

Additional Comments

Relates positively with adults *

Additional Comments

Cooperates in play *

Additional Comments

Uses materials purposefully *

Additional Comments

Respects class routines and rules *

Additional Comments

Is attentive *

Additional Comments

Listens in a group *

Additional Comments

Follows directions *

Additional Comments

Works without disturbing others *

Additional Comments

Completes tasks in a timely manner *

Additional Comments

Able to focus on one task *

Additional Comments

Is a self-starter *

Additional Comments

Has the applicant: 1) been recommended for any type of evaluation? 2) received support services? (speech, resource, etc)

Description of applicant. Please include outstanding qualities, as well as areas which indicate a need for further development.

Recommendation for Upcoming School Year – Please describe how you would assess the applicant’s development and academic readiness
for a structured first grade program.

Thank you so much for taking the time to complete this form. Your assistance helps us immensely!

This form will be emailed directly to the Office of Admissions at Northlake Christian School.

To the Teacher:

Physical Development

Reading Readiness

Beginning Math Skills

SOCIAL DEVELOPMENT/WORK HABITS

Thank you so much for taking the time to complete this form. Your assistance helps us immensely!

SOCIAL DEVELOPMENT/WORK
HABITS