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School Recomendation From 103 20181106

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A G S 2 0 1 9 | School Recommendation Form Page 1 of 5
2019 ARKANSAS GOVERNOR’S SCHOOL
SCHOOL RECOMMENDATION FORM
(No attachments allowed, except student transcript.)
NAME: ________________________________________________________________________________________________
(Last) (First) (Middle)
GENDER: _____________________ RACE
ADDRESS TELEPHONE (____) _______________
(Street) (City) (Zip Code)
HIGH SCHOOL TELEPHONE (____) _______________
ADDRESS SCHOOL DISTRICT ________________
COUNTY POPULATION OF JUNIOR CLASS ___________________
A G S 2 0 1 9 | School Recommendation Form Page 2 of 5
1. FORMAL TEST DATA. Give names of tests, dates administered, and appropriate standard score and percentile scores. Please
provide as much data as possible. Include sub-test scores for areas of application. Test data should not be more than two years
old and should be verified.
COMPOSITE
SUB-SCORE
TEST
NAME
DATE
Natl.
Percentile
Standard Score
National Percentile
Mental Ability: Group
Mental Ability: Individual
SAT
N/A
Verbal
Math
Writing
PSAT/NMSQT
N/A
Verbal
Math
Writing
ACT Test Scores and sub-
scores
Math
Science
STEM
English
Reading
Writing
ELA
ACT Aspire
Math
Science
STEM
English
Reading
ELA
Creativity
N/A
Plan
Other
Achievement Group:
(please identify)
Plan
Other academic test
_______________
_______________
Reading
Math
Soc. Sci.
Nat. Sci.
Lang. Arts
Other
A G S 2 0 1 9 | School Recommendation Form Page 3 of 5
2. ADDITIONAL INFORMATION. TO BE COMPLETED BY A FACULTY MEMBER, COUNSELOR, AND/OR ADMINISTRATOR
STUDENT’S NAME (LAST) (FIRST) (MIDDLE)
In order for the selection committee to be able to make a more informed decision. This section is for information which may not have been
presented in other parts of the application. Completion of this section may require the help of individuals who have extensive knowledge of the
student, his or her talents, ambitions, curricular or social needs, future plans, or other needs, etc. Other people could be contacted in order to
provide a summary of relevant information about the student. Limit remarks to available space. This should be typed and should not exceed
3,000 characters.
Name: _____________________________ Signature: _____________________________ Relationship to Student:_____________________
A G S 2 0 1 9 | School Recommendation Form Page 4 of 5
STUDENT’S NAME (LAST) (FIRST) (MIDDLE)
3. STUDENT EVALUATION
(TO BE COMPLETED BY FACULTY MEMBER, COUNSELOR, AND/OR ADMINISTRATOR. SOLICIT INPUT FROM OTHERS
FAMILIAR WITH SPECIFIC ASPECTS OF THE STUDENT’S ABILITIES AND INTERESTS, IF NECESSARY.)
Please note: A student who is not successful in a regular school environment is unlikely to be successful at AGS. Submit nominations
only if students are willing and able to attend and participate fully in the entire school. Please check the appropriate box, using this scale:
1 indicates a low demonstrated ability; 5 a high demonstrated ability. You may attach a separate typed page providing comments or
examples to support your evaluation. Include any unusual circumstances in this nominee’s life that create a particular need for consideration.
Please check here if you have attached a separate page of comments.
1 (Low ability) 2 3 4 5 (High ability)
Nominee has the ability and desire to cope successfully with advanced concepts, materials, and activities.
Nominee has a positive attitude about exploring new and different concepts and areas of study, including those in which he or she may not
be proficient.
Nominee shows maturity and consideration for others.
Nominee has demonstrated the ability to meet or exceed expectations of behavior.
Nominee can participate fully in a demanding schedule of activities and classes.
Nominee can use self-directed time wisely.
Nominee is likely to participate fully in interdisciplinary experiences, including student-created presentations.
Nominee is likely to participate actively in and complete the entire four-week program.
Name Signature Relationship to Student____________________________
A G S 2 0 1 9 | School Recommendation Form Page 5 of 5
4. DATA TO BE ATTACHED: Please make a readable copy of this student's transcript and attach it to
this form. It must show fifth semester grades and sixth semester courses.
______________________________________________________________________________________________________________
ATTEST: We have discussed pertinent information in this application with this student and agree that he/she is
interested in participating in the Arkansas Governor's School. To the best of our knowledge the student completed
student forms independently.
___________________________________________________ ___________________________________________________________
School District/Location Signature of Superintendent, Headmaster, Principal, or Parent if homeschooled
(Please indicate which one)
__________________________________ ________________ ________________________
Person Preparing School Recommendation Preparer’s Position Preparer’s Telephone Number
____________________________________________ _______________
School official who viewed student’s recorded audition Position
*Please note that uploaded, private YouTube videos should be reviewed. DVD formats should be viewed using a computer as well as a
DVD player.
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Completed 19 February 2020

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