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Student Lighthouse Team Criteria
Applicant:

________________________________________

Grade/Teacher:

________________________________

0

1

2

Strengths

did not attempt, or
items listed are very
inaccurate

attempted; some
items listed are
inaccurate

completed; most items
listed are accurate

Section 2:

did not attempt, or
selected all items

attempted; some
selected items are
inaccurate

completed; most items
listed are accurate

did not attempt, or
indicated no interest in
helping or bettering
MES

attempted; indicated
some interest in
helping and bettering
MES

completed; indicated a
great deal of interest in
helping and bettering
MES

not earning passing
grades in all subject
areas; received
several discipline
referrals within the
current school year

earning passing
grades in most subject
areas; received 2 or 3
discipline referrals
within the current
school year

earning passing grades
in all subject areas;
received no more than
1 discipline referral
within the current
school year

not confident; hurts
others; refuses to listen;
does not put-forth
effort socially or
academically
rated 1 or 2 in all areas

somewhat confident;
treats others with some
respect; puts-forth
some effort socially
and academically
rated 2 or 3 in all areas

confident; shows
empathy and patience
towards others; works
through social &
academic challenges
rated 3 or 4 in all areas

(5-10 total points)

(11-15 total points)

(16-20 total points)

Section 1:

Self-Inventory

Sections 3-5:
Motivation &
Practice

Grades &
Discipline
Refer to the Teacher
Recommendation Form.

Teacher
Recommendation
Refer to the Teacher
Recommendation Form.

Not Qualified

Potential

Ideal

Total Points
_________

Names of Application Evaluators:

DECISION:

________________________________

 Accepted (notify parent)
 Considered
 Not Accepted

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