2012-13 TEACHER EVALUATION TE For Spring 2013 or Fall 2013 Enrollment TO THE APPLICANT After 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 f(a~~u Jt' A/az t' ~~a~:le Last/family/Sur (Enter name exactly as it appears on official documents.) first/Given Middle (complete) Jt., etc. Birth Date ---I.-'O"---""'lfL+I_I,......,S-"' '+/-i/c...,.. -+Q-9+-' ....-:5,1--·---- CAID(CommonApp 10) _ . mm/dd/YY;~ I L Addr~s __ -+~~~~~~~~~b4.;-~--~flI~I~~~~----4-~--------~~~~-----------L~~~~~ _ School you now attend ~~-'--LL-/<-IL-'~y,f-----''--...L..LJ.4_I_+''<::::::;~+__l~'--V+---- CEEB/ACTCode _ country ZIP/Postal Code IMPORTANTPRIVACYNOTICE:Underthe terms of the Family Educational Rights and PrivacyAct (FERPA), after you matriculate you will have access to this form . and all other recommendations and supporting documents s~bmitted by you and on your behalf, unless at leastone of the following is true: 1.The institution does not save recommendations post-matriculation (see list at wWw.commonapp.org/FERPA). 2. Youwaive your right to access below, regardless of the institution to which it is sent: OYes, I do waive my right to access; and I unde;starid I will never see this form or any other recommendations submitted by me or on my behalf. @.No,I dopot waive myJight to access, an~ I m~y someoay choose tosee thi~ form or any'other recommend~tions or SUPP?0ingdocuments subm.ittegbyme •.•.. ...•.....• or on n1VBe. half to:th! Ji l1stitution Whichl'.'B,enrolllng; if thatirstituti.on saves thwnafterJmatriculate.\ ", '. ... . ,tIFt, ~;'/1',., Required Signature ~ j fJ ' " Date. 3o Z - I TO THE TEACHER The Common Application membership finds candid evaluations helpful in choosing from among highly qualified candidates. Youare 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 the college/university admission office. 00 not mail this form to TheCommonApplication offices. Teacher's Name (MrfM~/Ms'/Dr.) ---1Jrl e, i~,( fA weta t Subject Taught A I fl P 12 ra.. d.. J ere - [a.IL. U/ IIJ n I?' .''/)" Please prmt or type . ~ / Signature~_lALI £l!JdLAltUUJJLt Date /0/ q/ /:L mm/drJ/yyyy sec,"da~SChOOI~IW~~: H l~ iUIoo / School Address 23 oOJlJJ.1txan Mve JlU tin Number & Street CitylTown Teacher'sTelephone (~11)_( .... P~q-'-<.'-g~---J-I""J---"'O~q-'-- Teacher's E-mail Area/Country/City COGe Number 7'1 USf/ Ext. 7&211 ZIP/Postal Coao tt{/flt/e @f/ifdu( rJlj State/Province Country r--,~-,-"",", -,- ._ .. _. -~-----'---"---'-'- .. -.----..- .... --.-.-- -_.-.,_. ------_ .. -------., Background Information I I) ; . . I How long have you known this student and in what context? Ll.Jj-t'f:q..~ : 1/ t y m aM ft a c!1 t r ~ What are the first words that come to your mind to describe this student? le.~~~~~ I fI e d:._J::.!!E~ 171/ b/ -e J In which grade level(s)was the student enrolled when you taught him/her? 0 9 0 10 (0 11 • 12 0 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.). f n · ~ V I I ------~l I ~l~e~11t I yHtt (Ll Ul ~ ! I. ! , ! I!.-~~·.......,.,.,.,.._ •.•·__ ~,~·_~ •.•.•. A~_' .~~_ •.••• '_ •••..• r~_'=_· __ "'~ ...•..• -"'_'- __ ~.• ,~.,....._"' • ,.... __ ••~•. x_~~ , ......J c 2012 The Common Application, lnc, TEACHEREVALUATION1 AP-6/2012-13
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2012-13 TEACHER EVALUATION TEFor Spring 2013 or Fall 2013 Enrollment
TO THE APPLICANTAfter 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 f(a~~uJt' A/az t' ~~a~:leLast/family/Sur (Enter name exactly as it appears on official documents.) first/Given Middle (complete) Jt., etc.
Birth Date ---I.-'O"---""'lfL+I_I,......,S-"'·'+/-i/c...,..· -+Q-9+-' ....-:5,1--·---- CAID(CommonApp 10) _. mm/dd/YY;~ I L
Addr~s __-+~~~~~~~~~b4.;-~--~flI~I~~~~----4-~--------~~~~-----------L~~~~~~_School you now attend ~~-'--LL-/<-IL-'~y,f-----''--...L..LJ.4_I_+''<::::::;~+__l~'--V+---- CEEB/ACTCode _
country ZIP/Postal Code
IMPORTANTPRIVACYNOTICE:Under the terms of the Family Educational Rights and PrivacyAct (FERPA),after you matriculate you will have access to this form. and all other recommendations and supporting documents s~bmitted by you and on your behalf, unless at leastone of the following is true:1.The institution does not save recommendations post-matriculation (see list at wWw.commonapp.org/FERPA).2. Youwaive your right to access below, regardless of the institution to which it is sent:OYes, I do waive my right to access; and I unde;starid I will never see this form or any other recommendations submitted by me or on my [email protected],I dopot waivemyJight to access, an~ I m~y someoay choose tosee thi~ form or any'other recommend~tions or SUPP?0ingdocuments subm.itteg byme •.•..
. ..•.....•or on n1VBe. half to:th!Jil1stitution Whichl'.'B,enrolllng; if thatirstituti.on saves thwnafterJmatriculate.\ ", '. .. . . ,tIFt, ~;'/1',.,Required Signature ~ j fJ ' " Date. 3o Z
- I
TO THE TEACHERThe Common Application membership finds candid evaluations helpful in choosing from among highly qualified candidates. Youare encouraged to keep this formin your private files for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below beforemailing directly to the college/university admission office. 00 not mail this form to TheCommonApplication offices.
Teacher's Name (MrfM~/Ms'/Dr.) ---1Jrl e, i ~,( fA weta t Subject Taught A Ifl P 12ra.. d..Jere - [a.IL. U/ IIJn I?' .'' /)" Please prmt or type . ~ /
Signature~_lALI £l!JdLAltUUJJLt Date /0/ q/ /:Lmm/drJ/yyyy
sec,"da~SChOOI~IW~~: H l~ iUIoo /School Address23oOJlJJ.1txan Mve JlUtin
Number & Street CitylTown
Teacher'sTelephone(~11)_(....P~q-'-<.'-g~---J-I""J---"'O~q-'-- Teacher's E-mailArea/Country/City COGe Number
7'1 USf/
Ext.
7&211ZIP/Postal Coao
tt{/flt/e @f/ifdu( rJljState/Province Country
r --,~-,-"",",-,-._.._.-~-----'---"---'-'-..-.---- ..-....--.-.-- -_.-.,_.------_..-------.,Background Information I I) ; . . IHow long have you known this student and in what context?Ll.Jj-t'f:q..~ : 1/ty maM ft a c!1tr ~What are the first words that come to your mind to describe this student? le.~~ ~~~IfI ed:._J::.!!E~171/b/-e JIn which grade level(s)was the student enrolled when you taught him/her? 0 9 0 10 (0 11 • 12 0 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.).
fn· ~ V I I ------~lI ~l~e~11t I yHtt (Ll Ul ~
!I. !, !I!.-~~·.......,.,.,.,.._•.•·__ ~,~·_~ •.•.•.A~_' .~~_ •.•••'_ •••..•r~_'=_·__ "'~ ...•..• -"'_'- __ ~.• ,~.,....._"' • ,.... __ ••~•. x_~~ , ......J
c 2012 The Common Application, lnc, TEACHEREVALUATION1 AP-6/2012-13
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