EmailMe Form - Sixth through Eighth Grade Teacher Reference

Academy Hill enrolls students who are academically able and willing to challenge themselves, and who will add to our respectful and caring community. We appreciate your honest evaluation.

Student Name: *

Please rate each of the following criteria on a scale of 1-5.

Character *

POOR

1

2

3

4

OUTSTANDING

Responsibility *

POOR

1

2

3

4

OUTSTANDING

Trustworthiness *

POOR

1

2

3

4

OUTSTANDING

How do you rate the applicant as a person? *

POOR

1

2

3

4

OUTSTANDING

Please add comments that will support the candidacy of this student: *

Your Name *

First Last

Date *

MM / DD / YYYY

Phone *

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

School Name *

First Last

School Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

How long have you known the applicant? *

What is your relationship with this applicant? *