Reference Form for Ascend Micro School Application
To be completed by a teacher or other unrelated adult that knows the child well. This form and all its contents will be kept confidential. The purpose is to get to know the applicant better to help us determine if our school is a proper fit for him/her. Please contact us at ascendmicroschool@gmail.com with any questions.
Name of Student
First Name
Last Name
Name of Reference
First Name
Last Name
Email of Reference - for any follow-up questions
example@example.com
Phone Number of Reference - for any follow-up questions
-
Area Code
Phone Number
Relationship to child (teacher, coach, etc.)
How long have you known this child?
Social-Emotional Development Compared to Typical Peers
Below Norm
Typical
Above Norm
Very Strong
Cooperative
Leadership
Kindness
Empathy
Self-control
Respectfulness
Inclusiveness of others
Responsiblity
Joyfulness
Work Habits Compared to Typical Peers
Below Norm
Typical
Above Norm
Very Strong
Motivation
Organization
Listening Skills
Engagement
Frustration Point
Risk-taking
Self-awareness
Following Directions
Verbal Skills
Critical Thinking
Curiosity
What are this child's overall strengths?
What are some amazing characteristics and abilities of this child?
What makes this child unique?
What are some areas of concern and how does this child deal with these struggles?
Do you think this child would find success in a highly-individualized, project-based, non-traditional learning environment?
Yes
No
Are this child's parents supportive of their child, both their strengths and challenges?
Yes
No
Please share evidence to support your "no" above.
Are the parents involved in their child's school and/or extracurricular experiences?
Yes
No
Are the parents respectful of other adults and children in this child's life?
Yes
No
Please share evidence to support your "no" above.
Do you have any other comments or concerns regarding this child's application to Ascend Micro School?
Submit
Should be Empty: