Students Name:First NameLast NameThank you for your time in filling out this assessment form. We highly value your opinion, and this information is extremely important to us. All information will be held in the strictest confidence. Please note, we can only process this application once we have received this form. Reference Name:First NameLast NameCity:Relationship to Student:ex. teacher, neighbor etcCell Phone:Area CodePhone NumberE-mail:Best time to reach you:How Long do you know the Student?How frequently do you interact with the student?1. Commitment to Torah/Chassidishe IdentityPlease rate the student's traits from 1-4. (1= very much so, 2= mostly, 3= at times, 4= rarely)Is it apparent that she has Yirei Shomayim?1234Is she careful to be Tzniyus at all times?1234Does she set her Tzniyus Standards only because of school rules?1234Does she conduct herself in a Chassidishe manner?1234LearningEasily learns new concepts?1234Is attentive in class?1234Participates in class discussions1234is respectful of authority, rules and policies:1234Is open and eager to new learning experiences:1234Is consistant with school attendance and punctuality:1234Completes work and assignments responsibly:1234Personality/CharacterRespects others:1234Has a positive outlook:1234Values honesty & Integrity:1234Takes responsibility for her actions and words:1234Adaptable & Flexible1234Shares her feelings or opinions:1234Extends herself outside her own inner circle:1234Is sensitive to others:1234Stands up for what is right:1234Is self-confident:1234Conducts herself with Menchlichkeit:1234Contributes or volunteers:1234Demonstrates interest in personal growth:1234Has leadership qualities:1234Takes responsibility for her personal appearance (hygiene etc.)1234Please describe the student in a few sentences:Is there anything else you feel we should know to enable us to best help the student?By typing your name below, you are stating that the above information is true and that you agree that your electronic signature is the legal equivalent of your manual signature on this application.Signature*SubmitShould be Empty: This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.