Sch Forms C - 1st Grade Confidential Reference

Tree of Life Christian Preparatory School

A ministry of the Seventh-day Adventist Church

1^{st Grade Confidential Reference Form}

^{Student’s name: _________________________________________
Birth date: ___/___/___

To the teacher or School Director: we appreciate
your cooperation in completing this form which provides us with the benefit
of your observation of the child. All information that you furnish will be
kept confidential. Please place a check mark in the column that best
describes the child. You may place your check mark to the right or left
within the column to show graduations within each category – a mark to the
left would indicate more. This information is used with the understanding
that your observations are limited to the school setting, but will be
helpful in our full consideration of the applicant. Thank you for your time
on behalf of this student.
I have known this student for _____ years/months.}

Social Development	Usually	Sometimes	Seldom
Is supportive of peers
Is comfortable with adults
Plays well independently
Works well independently
Cooperates in classroom activities
Cooperates in play
Shares well
Initiates play activities
Is imaginative
Has capacity to lead
Has capacity to follow
Uses materials purposefully

Pre-Academic Skill Development	Usually	Sometimes	Seldom
Is attentive
Listens in a group
Contributes to group discussions
Follows directions
Works cooperatively
Completes tasks
Respects classroom routines
Moves easily from one activity to another
Responds positively to constructive criticism
Is curious
Is willing to try new activities
Is a self-starter
Exhibits problem solving abilities
Expresses ideas well
Enjoys new challenges

Physical Development	Outstanding	Age Appropriate	Needs Development
Small muscle control and coordination
Large muscle control
Speech development (articulation)

Please comment briefly on each of the following regarding this child:

1. Physical Development (general health and well-being)

2. Intellectual Development (attention span, language development, visual and auditory discrimination, favorite activities)

3. Social Development (degree of aggression or passivity, peer relationships, adult support needed, level of play)

4. Emotional Development (personality characteristics, self-image, ability to deal with conflict and frustration)

5. Child’s relationship with parents

6. Please describe child’s development of readiness for:

Beginning reading skills

Beginning math skills

7. In your view, what are this child’s particular strengths?

8. Are there significant weaknesses or problems of which we should be aware?

9. To your knowledge, has this child ever been evaluated for any physical, emotional or academic reasons?

10. What is the parent cooperation and involvement with the school?

11. Please make any further comments you feel are appropriate.

Have all financial obligations been met? ___ Yes ___ No ___ Not applicable

May we contact you if we have further questions? ___ Yes ___ No Telephone number : ___________________________

Signature: __________________________________________________ Date: ____________________________

School: ____________________________________________________ Position: __________________________

"Tree of Life Christian Preparatory School admits students of any race, color, ethnic background, country of origin or gender; proffers all the rights, privileges, programs and activities generally available to students; and, makes no discrimination on the basis of race, color, ethnic background, country of origin or gender in administration of education policies, application for admission, scholarship programs, and athletic or extracurricular programs."

"Preparing young minds for eternity."

6050 Plank Road • Fredericksburg, VA 22407 • 540-786-2019