CONFIDENTIAL TEACHER QUESTIONNAIRE: VILLIERS

Dear Parents Please have your childs teacher complete this form and have him/her return it to Villiers
directly either by fax, by email or in a sealed envelope. Thank you.
Name of Student: ___________________________________ Applying for year: _______________________
Parent signature for release of this information to Villiers:_________________________________________
Name of present school: ______________________________________________________________________
Country: _____________________________________ City: ________________________________________
Name of evaluator: _____________________________Subject taught: ________________________________
Length of time acquainted with student: _________________________________________________________
Please check the chart below with your impressions:
No Basis for
Judgement
Academic Ability
Motivation
Study Habits
Organizational Skills
Ability to Work Independently
Self-Discipline
Perseverance
Reaction to Criticism
General Behaviour
Ability to get along with Others
Politeness
Leadership
Self-Confidence
Warmth of Personality
Sense of Humour
Maturity

Below
Average

Average

Good

Excellent

Please share any additional information about the student (character, values, special interests, talents and
potential as a student). Feel free to expand on a separate sheet:
____________________________________________________________________________________
____________________________________________________________________________________

Please respond to the following questions:

1. Please assess the students standard of English:
Reading English: Beginner
Intermediate
Spoken English: Beginner
Intermediate
Written English: Beginner
Intermediate

Proficient
Proficient
Proficient

Native
Native
Native

What is the students first language? Bangla____________________________________________

Other languages studied + standard:
English______________________________________________________________________
____________________________________________________________________________________
2. Describe any particular academic strength or weakness:
He is very good in mathematics and science subjects____________________________________
3. Does the student have any special needs or learning disabilities? Yes No
Please describe: ______________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
4. Have there been any disciplinary, emotional or other concerns that we need to be aware of? Yes No
Please describe: ______________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
THANK YOU FOR YOUR COLLABORATION!
Evaluators signature: ____________________________Date: _________________________________
School Telephone Number: _______________________ School Email: __________________________
If you would like us to contact you regarding this student, please check here:
Please return this form to:

Villiers School,
North Circular Road,
Limerick
IRELAND
Tel.: +353 61 451447 email: secretary@villiers-school.com