Confidential Reference Request - 11+

Name of Student *

Students UPN *

Date of Birth *

Current School *

Date of Entry into Current School *

General academic achievement *

Oral contribution to lessons *

Ability to express themselves in writing *

Ability to grasp new concepts *

Ability to demonstrate independent working *

Imagination and Creativity *

Reading ability and level *

Short-term memory *

Long-term memory *

Ability to follow instructions *

Ability to concentrate *

Ability to work cooperatively in a group *

Social Integration *

Does this student have any specific education need? If so please outline below: *

Has this student received any form of learning support? If so please outline: *

Are there any education or health reports on this student? If so, please outline and provide a copy if possible *

Please comment on the candidate's personal qualities including conduct, confidence, motivation, initiative. *

Please comment on their relationships with peers and staff: *

Please comment on the student's behaviour for learning: *

Please comment on the student's contribution and interest in music, drama, sport and similar activities: *

Signature *

Clear Signature

Please sign above

Full name and position in school and date *

Confidential Reference Request for 11+ Application