Educational Reference Form

Corozal ITVET
TO BE FILLED OUT BY THE APPLICANT

This form should be filled by your homeroom teacher. The teacher is asked to fill this form and seal the
filled form in an envelope. All information in this form will be held in the strictest confidence and will not
be shared with students, parents or guardians.

Applicant’s Name
Surname First Name Middle Initials

Program Applying for Age Gender: M / F

Applicant’s Current/Previous School

Address of Current/Previous School

Telephone #

Applicant Signature Date

TO BE FILLED OUT BY THE RECOMMENDER

The information will be kept confidential. Please be as thorough as possible.

Name

Post School

Email Phone #

What is the greatest strength of this student?

What is this student’s greatest challenge?

Corozal ITVET Character Reference Form

Educational Reference Form
Corozal ITVET
What factors in the student’s home life would help or hinder his/her educational success?

What is this student’s attitude towards authority and rules?

Do you have any concerns in particular about this child? Yes / No If yes, please explain.

Have there been any disciplinary, emotional, or other concerns regarding this student?
Yes / No If yes, please explain.

Has the student ever been suspended or dismissed from school for disciplinary reasons?
Yes / No If yes, please explain.

In your opinion, has the student ever required learning support? Yes / No
If yes, please explain.

Please note any special interest and/or involvement in extra-curricular activities.

Parents’ involvement and support:

Are the parents supportive of the programs and policies of the school? Yes / No

Are the parents supportive of the child’s educational process? Yes / No

Do the parents communicate and cooperate with the classroom teacher? Yes / No

Do the parents acknowledge the student’s strengths and challenges? Yes / No

Corozal ITVET Character Reference Form

Educational Reference Form
Corozal ITVET
Below, please evaluate the student.

Never Occasionally Always

The student demonstrates self-discipline

The student follows directions

The student responds positively to the challenge of
academic work.
The student is able to follow classroom discussions
and participates willingly.
The student is able to express himself/herself clearly.
The student is respectful and courteous toward peers
and adults
The student displays a well-balanced temperament.
The student is able to work independently for an age-
appropriate period of time.
The student cooperates with others during group
activities.
The student makes good friends

The student completes tasks/homework.

The student seeks help when necessary.

Poor Average Excellent

Punctuality
Attendance
Reading skills
Writing skills
Academic Potential
Creativity
Leadership ability
Personal integrity
Intellectual curiosity
Sense of humor
Emotional maturity
Conduct
Concern for others

_________________________________ ________________________
Recommender’s Signature Date

Corozal ITVET Character Reference Form