________________________________________________________
_______________________________________________
(_______) __________________________________________________
Teacher Evaluation
TO THE APPLICANT
A
fter completing all the relevant questions below, give this form to a teacher who has taught you an academic subject (for example, English, foreign language, math,
science, or social studies). If applying via mail, please also give that teacher stamped envelopes addressed to each institution that requires a Teacher Evaluation.
Legal Name ___________________________________________________________________________________________________________________
Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.
Birth Date ___________________________________________________ CAID (Common App ID)
mm/dd/yyyy
Address ________________________________________________________________________________________________________________________
Number & Street Apartment #
City/Town State/Province Country ZIP/Postal Code
School you now attend CEEB/ACT Code _____________________________________
IMPORTANT PRIVACY NOTICE: By signing this form, I authorize every school that I have attended to release all requested records and recommendations to
colleges to which I am applying for admission. I also authorize employees at these colleges to confidentially contact my current and former schools should they
have questions about the information submitted on my behalf.
p
p
I waive my right to review all recommendations and supporting documents submitted by me or on my behalf.
I DO NOT waive my right to review all recommendations and supporting documents submitted by me or on my behalf.
• I have chosen not to waive my right to review my recommendations and supporting documents. I understand that my decision may lead my
counselors or teachers to decline to write recommendations on my behalf.
I also understand that my decision may lead colleges to disregard
any recommendations submitted on my behalf.
I understand that my waiver or no waiver selection above pertains to all colleges to which I apply and that my selections cannot be changed after any
recommendation or application submission.
Required Signature _____________________________________________________________________________________
Date _________________
TO THE TEACHER
Elizabethtown College finds candid evaluations helpful in choosing from among highly qualified candidates. You are encouraged to keep this form in
your private files for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below
before mailing directly to our college admission office. You may also fax this form to 717-361-1365 or email to apply@etown.edu.
Teacher’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________ Subject Taught
_______________________________________
Please print or type
Signature _________________________________________________________________________________________________ Date _____________________
mm/dd/yyyy
Secondary School _______________________________________________________________________________________________________________
School Address ________________________________________________________________________________________________________________
Number & Street City/Town State/Province Country ZIP/Postal Code
Teacher’s Telephone Teacher’s E-mail _____________________________________
Area/Country/City Code Number Ext.
Background Information
How long have you known this student and in what context? _______________________________________________________________________________
What are the first words that come to your mind to describe this student? _____________________________________________________________________
In which grade level(s) was the student enrolled when you taught him/her?
p 9 p 10 p 11 p 12 p Other_____________________________________
List the courses in which you have taught this student, including the level of course difficulty (AP, IB, accelerated, honors, elective; 100-level, 200-level; etc.).
_______________________________________________________________________________________________________________________________
E
lizabethtown College, One Alpha Drive, Elizabethtown, PA 17022
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