CONFIDENTIAL


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.

Fairfield CT, 06825 horizons@sacredheart.edu