Applicant Questionnaire
Commonwealth Academy appreciates your taking the time to offer a few observations and comments concerning the below-named student’s academic potential and personal attributes. One of our primary goals is that every student who enrolls in Commonwealth Academy has the ability to succeed. Your candid evaluation will help us assess the likelihood that this student will enjoy a successful educational experience and evaluate the effectiveness of our programs as they pertain to their needs.  This questionnaire is confidential and for Commonwealth Academy’s use only. Thank you for your assistance.
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Applicant Name *
Grade Applying for: *
Name of Individual Submitting this Form: *
Focusing only on the following ACADEMIC AREAS, select the option that best describes the applicant using the following rating scale:
1 - Emerging
2 - Developing with Support
3 - Proficient with Minimal Support
4 - Independent
5 - Advanced
NA - Not Applicable
 *
1
2
3
4
5
Not applicable
Reading
Math
Written Expression
Oral Expression
Listening Comprehension
Focusing on only the following EXECUTIVE FUNCTIONING areas, select the option that best describes the applicant using the following rating scale:
1 - Emerging
2 - Developing with Support
3 - Proficient with Minimal Support
4 - Independent
5 - Advanced
NA - Not Applicable
 *
1
2
3
4
5
Not applicable
Organization
Planning
Emotional Stability/Self Control
Adaptability & Mental Flexibility
Attention
Initiative
Behavioral Issues
Teamwork
Self Advocacy
Focusing only on the following CHARACTER ATTRIBUTES, select the option that best describes the applicant using the following rating scale:
1 - Emerging
2 - Developing with Support
3 - Proficient with Minimal Support
4 - Independent
5 - Advanced
NA - Not Applicable
 *
1
2
3
4
5
Not applicable
Social Awareness
Leadership
Social Open-Mindness
Work Ethic
Intellectual Engagement
Resilience
What is your relationship to the applicant? *
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