Adolesco | Teacher’s Reference Questionnaire

The parents of the child referenced on this questionnaire have given their permission for you to answer these questions about their child; feel free not to answer any questions you are unsure about. Please note that your responses will remain completely confidential. Ahead are nine short questions – thank you in advance for your time!

Teacher’s Reference

Your Name*
Name of child/teenager concerned:*
Academic level of child's class
Child's Academic Ability
Are they well integrated in class and at school in general?
How do they get along with their classmates?
Do you think that this student would be capable of spending three weeks to three months in a foreign country with another family?
Select the options that best describe the child/teen:
- Well-behaved
- Accepts correction/guidance
- Hard-working
- Listens to directions
- Participates in class
- Organized
- Not easily distracted
Any other comments you would like to add about the child/teen and/or their behavior: