Single Parent Program Recommendation Form
Student ___________________________________ Student ID Number __________________
Course /Section ___________________________________ Semester/Year _________
The above student has applied to the Single Parent program and has given consent for you to
release the information requested below. We are interested in your perspective on their
academic performance. Please remember to add your name and date at the bottom.
After you complete this form, email or send it through interoffice mail to Karen Mosley at
mosleylk@durhamtech.edu as soon as possible so we can process the student’s application.
Please check the boxes below that describe this student’s performance and/or status in your
Does the student:
Makes/made a strong effort in this class
Has a good attendance record. Student has been absent for _____ out of _____classes.
Participates/participated during class
Completes/completed assignments on time
Is earning/earned a grade of C or better
Other comments (optional, but helpful)
Instructor Name _____________________________________
Instructor Signature _____________________________________ Date __________________
Revised 8/2019
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