Horizons at Sacred Heart University
Student Evaluation Form
To the Teacher: The applicant has applied to Horizons at SHU, a summer academic and enrichment program. The information requested below provides one way of getting to know the child and is reviewed with the understanding that the child is constantly changing and developing. We particularly value your observations of classroom behavior and your descriptive comments.
Our goal is to admit children that are the best fit for our program. Two-thirds of the students we accept are considered to be “below grade level” in literacy and/or math. We meet the child where he or she is and appreciate your help in providing information that we can use to determine how best to help the child learn and grow this summer. This evaluation will be kept in strict confidence and used solely to help inform a thoughtful admission decision. Please be assured that all information will remain confidential. We appreciate your cooperation in completing this form. Please call with any questions or to discuss (203) 396-8484.
Name of Applicant
Name of School Teacher:
Current grade as of the 2019 – 2020 school year: Anticipated grade for the 2020 – 2021 school year:
Social/Emotional Development | Area of Concern | Needs Development | Age Appropriate | Exceeds Age Expectations | Comments |
Cooperates in play/group work | 1 | 2 | 3 | 4 | |
Engages appropriately with peers | 1 | 2 | 3 | 4 | |
Is comfortable with adults | 1 | 2 | 3 | 4 | |
Exhibits curiosity | 1 | 2 | 3 | 4 | |
Exhibits self- control | 1 | 2 | 3 | 4 | |
Tolerates frustration | 1 | 2 | 3 | 4 |
Physical Development | Area of Concern | Needs Development | Age Appropriate | Exceeds Age Expectations | Comments |
Fine motor control | 1 | 2 | 3 | 4 | |
Gross motor control | 1 | 2 | 3 | 4 | |
Speech development | 1 | 2 | 3 | 4 |
Skill Development | Area of Concern | Needs Development | Age Appropriate | Exceeds Age Expectations | Comments |
Follows directions | 1 | 2 | 3 | 4 | |
Stays on task for appropriate lengths of time | 1 | 2 | 3 | 4 | |
Accepts limits/redirection | 1 | 2 | 3 | 4 | |
Makes transitions easily | 1 | 2 | 3 | 4 | |
Expresses ideas and needs | 1 | 2 | 3 | 4 |
Academic Development | Area of Concern | Needs Development | Age Appropriate | Exceeds Age Expectations | Comments |
Reading and decoding skills | 1 | 2 | 3 | 4 | |
Reading comprehension | 1 | 2 | 3 | 4 | |
Math computation | 1 | 2 | 3 | 4 | |
Math problem solving | 1 | 2 | 3 | 4 | |
Attention span | 1 | 2 | 3 | 4 | |
Motivation | 1 | 2 | 3 | 4 |
Services and Supports | Yes | No | Comments |
Does the student have a 504? | |||
Does the student have an IEP? | |||
Did the student qualify for ELL services? | |||
Did the student qualify for tiered support? | Please designate the content area and tier |
Please comment on each of the following regarding this child. Please use the back if more space is required. What are the students favorite activities/subjects:
What adjectives come to mind when you think of this applicant?
Describe the level of parent cooperation and involvement:
What challenges does this child face as a learner:
In what specific areas would you like to see this student grow this summer?
Is there anything else you think we should know about this student?
Teacher Contact Information
Name (Please print) School Name
Telephone Email
Signature Date
Please return this form directly to: Jaime Perri, Executive Director Horizons at Sacred Heart University 5151 Park Ave.