Arlin gt on High School
5475 Airline Road
Arlington, TN 38002
Phone: 901.867.1541
Fax: 901.867.1546
Arlington Community Schools
http://www.acsk-12.org
__________________________________________________________________________________________________________________
Arlington
Scholars
Program
Teacher/Community
Member
Recommendation
Form
To
the
Applicant:
Complete
the
personal
information
below,
and
deliver
this
form
to
the
Teacher
or
Community
Member
of
your
choice.
Provide
an
envelope
to
be
sealed,
taped,
and
signed
by
the
person
who
recommends
you.
!
Name
of
Applicant:
__________________________________________________________________________________
Applicants
Home
Address:
___________________________________________________________________________
Current
School:
____________________________________________________________________________________
To
the
Teacher/Community
Member:
The
student
named
above
is
a
candidate
for
admission
to
Arlington
High
Schools
Scholars
Program.
Your
recommendation
is
vital
to
our
process
as
our
admission
committee
examines
the
academic
and
personal
qualifications
of
each
candidate.
Please
respond
candidly
and
thoughtfully.
Once
completed,
place
in
envelope,
seal,
tape,
sign
across
the
tape,
and
return
to
the
student.
Please
complete
and
return
immediately.
How
well
do
you
know
the
student?
____________________________________________________________________________________
What
are
the
first
three
words
that
come
to
mind
when
describing
this
student?
__________________________________
______________________________________________________________________________________________________________________________
Personal
Qualities:
Please
place
check
marks
at
the
points
that
represent
you
evaluation
of
the
student
in
comparison
to
other
student
in
his
age
group.
Excellent
(3)
Good
(2)
Fair
(1)
Below
Average
(0)
Personal
Conduct
!
Leadership
Potential
Concern
for
Others
Honesty/Integrity
Self-Esteem/Self-Confidence
Motivation
Responsibility
Respect
for
Authority
Respect
Accorded
by
Peers
Emotional
Stability
Participation
in
School/Community
Activities
Overall
Evaluation
as
a
Person
TOTAL
POINTS
_______
Academic
Qualities:
Please
place
check
marks
at
the
points
that
represent
your
evaluation
of
the
student
in
comparison
to
other
students
in
his
age
group.
Excellent
(3)
Good
(2)
Fair
(1)
Below
Average
(0)
Academic
Potential
Ability
to
Learn
Intellectual
Curiosity
Motivation/Effort
Ability
to
Work
Independently
Ability
to
Work
Cooperatively
Organization
Creativity
!
Willingness
to
take
Intellectual
Risks
Oral
Communication
Skills
Study
Habits
Overall
Evaluation
as
a
Person
TOTAL
POINTS
_______
Please
comment
on
this
students
character,
citizenship,
and
contributions
to
your
community.
Feel
free
to
complete
on
a
separate
page
if
necessary.
Overall
Recommendation:
Please
place
a
check
mark
at
the
point
that
represents
your
overall
recommendation.
With
Enthusiasm
Strongly
Recommend
Recommend
with
Do
Not
Recommend
Recommend
Reservation
This
report
will
not
be
disclosed
to
the
applicant.
It
will
only
be
available
to
the
administrators
of
the
Scholars
Program
for
admission
decisions
to
the
Program.
If
you
have
any
questions
in
relation
to
the
Scholars
Program,
please
feel
free
to
contact
the
AHS
guidance
office
at
901.867.1541
for
additional
information.
__________________________________________________________________________________________________________________________________
Signature
Position
Date
!
__________________________________________________________________________________________________________________________________
Print
Name
Email
Address
Phone
Number
Street
Address
City/State/Zip
Code
