Common Application Form – Fill Out and Use This PDF

		2011-12 TEACHER EVALUATION	TE
		For Spring 2012 or Fall 2012 Enrollment

TO THE APPLIC ANT

After completing all the relevant questions below, give this form to a teacher who has taught you an academic subject (for example, English, foreign language, math, science, or social studies). If applying via mail, please also give that teacher stamped envelopes addressed to each institution that requires a Teacher Evaluation.

Female

Legal Name ___________________________________________________________________________________________________________________
			Male
Last/Family/Sur (Enter name exactly as it appears on official documents.)	First/Given	Middle (complete)	Jr., etc.

Birth Date ___________________________________________________ CAID (Common App ID) _______________________________________________

mm/dd/yyyy

Address ________________________________________________________________________________________________________________________

Number & Street	Apartment #	City/Town	State/Province	Country	ZIP/Postal Code
School you now attend ________________________________________________________				CEEB/ACT Code _____________________________________

IMPORTANT PRIVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERPA), after you matriculate you will have access to this form and all other recommendations and supporting documents submitted by you and on your behalf, unless at least one of the following is true:

1.The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA).

2.You waive your right to access below, regardless of the institution to which it is sent:

Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted by me or on my behalf.

No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me or on my behalf to the institution at which I'm enrolling, if that institution saves them after I matriculate.

Required Signature _______________________________________________________________________________________ Date _________________

TO THE TEACHER

The Common Application membership finds candid evaluations helpful in choosing from among highly qualified candidates. You are encouraged to keep this form in your private files for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below before mailing directly to the college/university admission office. Do not mail this form to The Common Application offices.

Teacher’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________ Subject Taught _______________________________________

Please print or type

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy

Secondary School _______________________________________________________________________________________________________________

School Address ________________________________________________________________________________________________________________

Number & StreetCity/TownState/ProvinceCountryZIP/Postal Code

Teacher’s Telephone (_______) __________________________________________________ Teacher’s E-mail _____________________________________

Area/Country/City CodeNumberExt.

Background Information

How long have you known this student and in what context? _______________________________________________________________________________

What are the first words that come to your mind to describe this student? _____________________________________________________________________

In which grade level(s) was the student enrolled when you taught him/her? 9 10 11 12 Other_____________________________________

List the courses in which you have taught this student, including the level of course difficulty (AP, IB, accelerated, honors, elective; 100-level, 200-level; etc.).

_______________________________________________________________________________________________________________________________

Ratings Compared to other students in his or her class year, how do you rate this student in terms of:

							One of the top
				Very good			few I’ve encoun-
	Below		Good (above	(well above	Excellent	Outstanding	tered
No basis	average	Average	average)	average)	(top 10%)	(top 5%)	(top 1%)

Academic achievement

Intellectual promise

Quality of writing

Creative, original thought

Productive class discussion

Respect accorded by faculty

Disciplined work habits

Maturity

Motivation

Leadership

Integrity

Reaction to setbacks

Concern for others

Self-confidence

Initiative, independence

OVERALL

Evaluation Please write whatever you think is important about this student, including a description of academic and personal characteristics, as demonstrated in your classroom. We welcome information that will help us to differentiate this student from others. (Feel free to attach an additional sheet or another reference you may have prepared on behalf of this student.)