Referral Form
The Brook Hills Co-op is a fee-for-service tutorial designed for elementary, middle, and high school students, grades K-12. Our mission is to support and encourage families as they lay a foundation for lifelong learning and discipleship. We desire to partner with students and families effectively, and your reference is vital to that process.
Email *
Name of applicant/student *
Current grade level (2023-2024) *
Your name *
Your email address *
Your phone number *
Your position (please check one) *
Required
Name of organization where reference's position is held. *
How long have you known this student and in what capacity?
 *
What strengths have you observed in this student?
*
What are areas where this student needs to grow and mature?
 *
Is this student in good standing with the church/school and allowed continued attendance?
 *
If no to the previous question, please explain.

Please mark the appropriate evaluation for each statement: 

 *
Never
Occasionally
Usually
Always
The student is kind to others.
The student is disciplined.
The student listens well.
The student respects authority.
The student exhibits self-control (not disruptive).
The student follows directions.
The family values educational partnership.
The family is dependable and committed.
The family is committed to homeschooling.
The family manages time well (academics, homelife, activities, church).
Is there anything else BHC needs to know in consideration of this student?
Please write your name and date to complete this form.  *
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