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

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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.
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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? __________________________________

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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




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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




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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.

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Signature


Position


Date

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Print Name
Email Address

Phone Number


Street Address





City/State/Zip Code