Student Feedback Form


This form is intended to be filled out by a TEACHER and returned to the counselor. The information
provided below may be used by the counselor for recommendations/college applications.
SUBJECT TAUGHT_____________________________ fr so jr sr (circle year taught)
1. What are the first word that come to mind to describe the student:
As a person:
As a student in your class:
As a member of your high school community:
2. Please check the item(s) that most appropriately describe this student:
a. Participation in discussion (self-initiated)
____ always involved, often initiates discussion
____ usually participates
____ often participates
____ occasionally participates
____ not applicable
b. Involvement in classroom activities
____ actively participates in all activities
____ active, usually shows genuine interest
____ mild, politely attentive
____ languid, attention often wanders
____ distracted, does other things during class
____ attention and focus varies greatly
c. Pursuit of independent study
____ considerable study and major project(s)
____ considerable study or major project(s)
____ some study and minor project(s)
____ no evidence of independent study
____ not applicable
d. Consistency of performance
____ exceptionally consistent
____ even, varies no more than one grade
____ slightly uneven, often varies by one grade
____ uneven, often varies two grades
____ erratic performance, fluctuates greatly
e. Critical and questioning attitude
____ often challenges
____ sometimes challenges
____ occasionally is skeptical
____ sometimes probes
____ rarely questions
____not applicable


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