Summit Scholars -  School Report/Teacher Evaluation
THIS FORM SHOULD BE COMPLETED BY THE STUDENT'S PRIMARY TEACHER OR A SCHOOL ADMINISTRATOR, and will assist the Admission Office in evaluating the student for placement in our supplemental, after school Summit Scholars learning program starting the fall of 2024.

We appreciate your cooperation and candor in completing this form. It provides one way of getting to know the student and is reviewed with the full awareness that students are constantly changing and developing. Please note that we place particular value on your observations on academic ability, motivation, classroom behavior, and your descriptive comments in each area. This evaluation will remain confidential.
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Student Name *
Student grade in 2023 - 2024 academic year *
How well do you know the student academically? *
How well do you know the student as a person? *
Grades served by your school: *
Number of students in your entire school: *
During which months is your school in session? *
Please explain your school's grading system. What is the passing mark? Honors mark? *
Approximately where does the student's academic performance place him in relation to his peers? *
Please indicate the number of days the student has been absent, tardy, or dismissed early each year while at your school. Does the student have an unusual number of absences/tardies from school? If yes, please explain. *
If the student is not, or has not been, in good academic standing, please explain. *
Should we be aware of any factors that have influenced the student's progress? *
Has the student ever been dismissed, suspended, placed on probation, or received other serious disciplinary sanctions? If yes, please provide a full explanation. *
Has the student withdrawn from school voluntarily for an extended period of time? If yes, please provide a full explanation. *
Please rank this student in the following areas: *
One of the top few
Excellent - Top 10% this year
Above average
Average
Below average
No basis for judgement
Academic potential
Academic achievement
Intellectual curiosity
Effort/Determination
Ability to work independently
Organization
Creativity
Willingness to take intellectual risks
Concern for others
Honesty/Integrity
Self-esteem
Maturity (relative to age)
Responsibility
Respect accorded by peers
Respect accorded by faculty
Emotional stability
Overall evaluation as a person
Overall evaluation as a student
If the student is relatively weak or strong in any areas listed above, please elaborate: *
What are the first three words that come to mind when describing this student? *
Please comment on this student's academic motivation, academic skills, intellectual curiosity, character, citizenship, and contributions to your community. *
Please add any additional information that will give us a more complete picture of the student.
Please share any relevant information about the family-student relationship and/or the family-school relationship.
Thank you for taking your valuable time to complete this application!
Your reflections are an important part of the student's application. In addition to submitting the School Report/Teacher Evaluation form, please also send the following as requested by the student's family to admission@belmonthill.org:
  • Current academic year transcript/report cards (2023-2024)
  • Comprehensive transcript from previous academic year (2022-2023)
  • Attendance record
  • Discipline record, if any
  • Standardized testing (e.g. MCAS, ERBs), if available

I understand that typing my first and last name in the box below constitutes my legal signature and confirms the truthfulness of the information provided in this form. *
Date *
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Position *
School *
Email address *
Phone *
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