Fairfield Middle School STEM Early College Academy Recommendation Form Please complete this recommendation form to the best of your knowledge. If you prefer, this recommendation form is also available online at tinyurl.com/FMSSTEMRec. Student’s Last Name: _______________________ Student’s School:

Student’s First Name: _______________________

________ Fairfield Elementary School ________ Fairfield Magnet School for Math and Science ________ Geiger Elementary School ________ Kelly Miller Elementary School ________ McCrorey-Liston School of Technology ________ Other: ______________________________

Your Name: _____________________________ Relationship to the Student: ____ Current Teacher ____ Former Teacher ____ Administrator ____ Guidance Counselor ____ Other: ___________________________ Contact Phone Number: _______________________________

Contact Email: ____________________________________

Based on your knowledge of the student, please rate his/her performance using the table below.

Category Ability to communicate Organizational Skills Work Ethic

(Weak) 1

2

Ability to overcome frustration Ability to collaborate with others (continued on back)

3

4 (Strong)

N/O

Based on your knowledge of the student, please answer the statements in the table below. Category (Not at all) 2 3 (Very much) N/O 1 4 Setbacks discourage this student. This student finishes whatever he/she begins. This student loses interest in projects easily. This student has support from his/her parent(s) or guardian(s).

Describe the student’s accomplishments. __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ What other information do you know that will give us a good picture of this student? __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ Please return the completed form in a sealed envelope to the student. The application and recommendation forms are due to Fairfield Middle School by 4:00 P.M. on Thursday, February 16, 2017.