EmailMe Form - Early Learner/PreK, Kindergarten and Grade One

We appreciate your cooperation in completing this form. It provides a lens through which to gather insight about the candidate, fully understanding that young children are constantly changing and developing. We place particular value on your observations of classroom behavior and your descriptive comments. This evaluation will be kept in strict confidence.
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: *
Days Per Week Enrolled *
Hours Per Day *
Size of Group
Age Range

Social and Emotional Development *

	Exhibits Strength	Age Appropriate	Needs Development
Befriends Classmates
Supportive of Peers
Comfortable with Adults
Plays Happily When Alone
Cooperative
Shares Well
Initiates Play
Exhibits Appropriate Humor
Capacity to Lead
Capacity to Follow
Uses Materials Purposefully
Imaginative

Cognitive Development *

	Exhibits Strength	Age Appropriate	Needs Development
Attentive
Demonstrates Ability to Focus on One Task
Works Cooperatively
Completes Tasks
Listens in groups
Respects Classroom Routines
Expresses Ideas Well
Moves Easily From One Activity to Another
Responds Positively to Constructive Criticism
Curious
Willing to Try New Activities
Self-Starter
Enjoys New Challenges
Exhibits Problem-Solving Abilities

Descriptive Comments:
Motor and Speech Development *

Exhibits Strength Age Appropriate Needs Development

Small Muscle Control and Coordination

Large Muscle Control and Coordination

Speech Development
Please identify and describe any special needs, including auditory and visual development. *
FAMILY INFORMATION
Please comments on parent/guardian cooperation and support for the child's school experience. *
GRADE ONE APPLICANTS ONLY
Describe beginning math skills:
GRADE ONE APPLICANTS ONLY
Describe beginning literacy or reading/writing skills:
We encourage you to add additional other information which you think would be helpful. Include comments concerning strengths, weaknesses or any special needs or concerns of this child and/or family. *
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
I have known this child for *
My relationship has been that of *

	Exhibits Strength	Age Appropriate	Needs Development
Small Muscle Control and Coordination
Large Muscle Control and Coordination
Speech Development