Multicultural and International Programs

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Students Name:

School:

Present Grade: Date:

The above mentioned student has applied to THE FIRST STEP Summer Institute. We would like to have some information about this student so that we can decide whether she will benefit from being a part of the program.

Name of Teacher/Counselor:

School and Position:

School Phone:

How long have you known the applicant?

Please circle the Five words that best describe this student (if not provided, write in space)

Self-disciplined
Disruptive
High potential
Highly motivated
Responsible
Quick learner
Team Player
Independent
Role model
Positive Learner
Goal-oriented
Leader
Negative
Quiet/Shy
Follower
Good Listener
Poor Listener
Domineering


How will this student benefit from being part of the First Step program?



Are there any unusual situations that may affect her performance?



Additional comments:





Signature: Date: