Reference Form

Heather Anderson

Please complete the following form in reference to Riona Patel:

Recommendation for RCS Academic Magnet Program

A student who has applied for admission to an Academic Magnet program within Rutherford County Schools (TN) has asked that you provide a recommendation for him/her.

Please thoughtfully complete this brief recommendation form for the requesting student. We are looking for students with individual determination. Your honest feedback will help us ensure we select the right students who are prepared for the rigors and high expectations of our Academic Magnet program.

There are a few questions below that are required. Those questions have a red star to note that they are required. At the end of the form, please enter any additional comments you deem important.

Finally, you will be asked to sign this document by using your mouse, or trackpad. This is to simply certify your answers. Thank you for your time and consideration!

* If you would rather not complete a reference for this student, please select the 'Opt Out' button at the bottom left of this form.

Reference Information

Person Submitting Recommendation:

Email Address of Person Submitting Recommendation:

In what capacity do you know the applicant?:

Reference Questionnaire

Important! Please use the following rating scale for the below questions:

1=Poor, 2=Below Average, 3=Average, 4=Above Average, 5=Exemplary

The student listens while others speak:

The students stays focused and on task:

The student expresses wants and needs appropriately:

The students participates willingly in activities:

The student follows class rules and expectations:

The student is intellectually curious and intuitive:

The student works well independently:

The student works well in a group setting:

The student is organized:

The student exhibits good self-control:

The student is encouraged by family members:

The student completes assignments:

The student expresses himself/herself well:

The student is self-motivated and exhibits initiative:

The student has the support of parents:

The student can handle multiple tasks:

The student is responsible for assignments, actions, and meeting deadlines:

The student shows respect for himself/herself and others:

The student adapts easily to new situations and environments:

The student possesses leadership qualities:

Misc. Information

Please comment on the applicant's strengths and weaknesses academically. Be as specific as possible.:

Please comment on the applicant's character and classroom behavior. Be as specific as possible.:

Please indicate to what degree you recommend the applicant for an advanced, fast paced curriculum. (Enthusiastically / Confidently / With Reservation / Do Not Recommend):

Thank you for taking your valuable time to complete this evaluation. Your honest reflections are an important part of the student's application. Recommendations become confidential property of Rutherford County Schools and are not subject to parent or applicant review. Please enter your e-Signature below, where prompted.

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Heather Anderson

Recommendation for RCS Academic Magnet Program

Reference Information

Reference Questionnaire

Misc. Information

Your signature is required.