Student Evaluation Form - Washington

GonzaGa PreParatory School
Student evaluation Form
For IncomInG 9
th
Grade StudentS
note to Student and Parent: this survey form is to be delivered to the appropriate school official (teacher, counselor
or principal) and returned to Gonzaga Preparatory School, 1224 e. euclid Spokane, Wa 99207.
SectIon I - to Be comPleted By Parent or GuardIan
Please Print or type
Student’s name____________________________________________date of Birth ____________________
Last First Middle
Parent/Guardian __________________________________________________________________________
Last First Middle
Parent contact email ______________________Parent contact Phone number ______________________
Present School ____________________________________________number of years attended _________
I authorize ___________________________________ School to release all educational, disciplinary, and
counseling records and information pertaining to my student to Gonzaga Preparatory School.
Parent or Guardian Signature_______________________________________ date signed ____________
note: This authorization must be signed and dated in order for the student to be considered for admission.
ParentS: the Federal educational rights and Privacy act (FerPa) or other laws or school policies may guarantee you rights to
view your child’s education records or to access the information within them. Gonzaga Prep is suggesting you waive any such
rights with regard to this Student Survey Form after it is completed, so that the school official(s) completing it may feel free to
give a candid appraisal of your student’s abilities and the suitability of Gonzaga Preps program for him/her. you are not obliged
to sign the following waiver as a condition of your son/daughter being considered for admission to Gonzaga Prep.
WaIVer
I hereby request and direct an official(s) of the above-named school to complete this Student Survey Form; in so doing, I waive
any rights I or my spouse or student might otherwise have had under FerPa or other law or school policies, as to Gonzaga
Preparatory School or the school above-named, to view this Form after completion or to access any of the information conveyed
by the completed Form:
Parent or Guardian Signature_______________________________________ date signed ______________
SectIon II - to the teacher, counSelor or PrIncIPal
this student is applying for admission to Gonzaga Prep for the coming school year. PleaSe comPlete thIS Form aS
comPletely and accurately aS PoSSIBle so that a fair evaluation of the student may be made. candid answers are
appreciated. this information is used for admissions and to help assist with proper placement in courses. this information will
remain confidential if the waiver in Section I has been signed by a parent or guardian.
• Please submit a copy of the students nal 7th grade report card, and his/her grade reports for the rst
grading period of the 8th grade year.
• Please indicate this students current grade point average:
4.00 - 3.50 3.49 - 3.00 2.99 - 2.50 2.49 - 2.0 below 2.00
• Does this GPA reect accommodations? Yes No
If yes, please explain _______________________________________________________________________
• Does this GPA reect modied course of studies? Yes No
If yes, please explain _______________________________________________________________________
• Please submit the student’s most recent standardized test scores.
• Do you think the test scores reect actual achievement? Yes No
GONZAGA
P
REPARATORY
SCHOOL
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