Teacher Referral Form
Francis Libermann
Catholic High School
An Enriching and Empowering program for young women and men.
Grade 8 Teacher Recommendation – Confidential
Instructions:
In order to ensure confidentiality, you are kindly asked to complete this Grade 8 Teacher
Recommendation Form and place it in a sealed envelope with the student’s name on the front and
your signature across the seal on the back. Please send this completed form via courier directly
to ‘Ms. Laila Velocci’, Vice-Principal, Francis Libermann C.H.S by Tuesday, November 26,
2013.
Teacher’s Name: _______________________________
Student’s Name: __________________________________
Elementary School: _____________________________
School’s Tel. #: ___________________________________
School’s Address: _______________________________________________________________________________________
Part I: Please answer the following questions regarding the student named above.1 being the lowest
score and 4 being the highest score possible
Work Habits
Lowest
Highest
Works independently
1
2
3
4
Works well in groups
1
2
3
4
Meets deadlines
1
2
3
4
Shows initiative
1
2
3
4
Communication
Lowest
Highest
Effectively communicates ideas
1
2
3
4
Contributes to class discussions
1
2
3
4
Ability to handle conflict situations
1
2
3
4
Responsible Citizen
Lowest
Highest
Attendance record
1
2
3
4
On time for class
1
2
3
4
Cooperative and positive attitude
1
2
3
4
Demonstrates respect for others
1
2
3
4
Francis Libermann Catholic High School
4640 Finch Ave. East – Scarborough, Ontario M1S 4G2
Teacher Referral Form
Life Skills
Lowest
Highest
Solves problems independently
1
2
3
4
Uses educational resources effectively
1
2
3
4
Shows flexibility
1
2
3
4
Learning Style
Lowest
Highest
Self-directed and takes responsibility for
her/his own learning
Sets goals and follows through with them
1
2
3
4
1
2
3
4
Shows interest in learning
1
2
3
4
Goes beyond curriculum expectations
1
2
3
4
Shows interest in world & current events
1
2
3
4
Finds creative solutions to problems
1
2
3
4
Part II: Please comment on the following:
Do you believe the student possesses the academic ability, work habits and interpersonal skills needed to be successful
in an enriched academic Math, Science, English and Technology program?
Please provide any additional comments that you feel would assist us in assessing this student for admission to the
Libermann MST program.
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Teacher’s Signature
Date
Thank you for taking the time to complete this recommendation form.
Francis Libermann Catholic High School
4640 Finch Ave. East – Scarborough, Ontario M1S 4G2