Student LHT TEACHER REC. FORM .pdf

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Student Lighthouse Team
Teacher Recommendation Form
Applicant’s Name: ________________________________

Grade: ________

Teacher’s Name: __________________________________

Subject Taught: ______________

The above student is applying for the MES Student Lighthouse Team. You can help select the future
members of the Student Lighthouse Team by rating this student in the following areas:

This student is…
Disagree

Agree

Reliable/Trustworthy

1

2

3

4

Confident

1

2

3

4

Comfortable Meeting New People

1

2

3

4

Able to Communicate Clearly

1

2

3

4

A Positive Role Model

1

2

3

4

Total Points: ___________

 The student submitted the application by the deadline.
 The student is earning a passing grade in each subject area.
 The student has received no more than ONE discipline referral within the
current school year.

Additional Comments:

Please place this form in the box of Loryn Acker (K-2) or Rachel Ingram (3-5) by December 9.
Your responses will be kept confidential.

________________________________________________
Teacher Signature

_________________
Date


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