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Rutherford Tutorial Academy

( Recommendation Form )

This recommendation form is for a student who is applying to a homeschool tutorial group.  That student should fill out the first three lines of this form and supply a stamped envelope to the person who is making the recommendation.  Please mail this to:

Diane Cothern, 2307 Riverview Dr., Murfreesboro, TN  37129, rather than returning

it to the student.  Thank you for your cooperation.

Recommendation for: _________________________________________________ 

From:_____________________________Address:__________________________ 

Phone (Home):____________________(Office)____________________________ 

How long have you known this student?___________________________________  

In what capacity/relationship?___________________________________________ 

Indicate your assessment of the student in the following categories:  (If you do not

know, please indicate.)

Emotional Stability:

Sense of Humor:

Academic Ability:

Respect for Authority:

Ability to Work Independently:

Ability to Work With Others:

Does he/she complete tasks he/she starts?

Does this student take responsibility for his/her own actions?

Please attach a statement to describe other attributes that make this person a good

candidate for an academic program that requires a high level of cooperation,

maturity and academic independence.

Do you recommend this student as an asset to our program:___________________

Signature:_______________________________________   Date:______________

Rutherford Tutorial Academy

( Recommendation Form )

This recommendation form is for a student who is applying to a homeschool tutorial group.  That student should fill out the first three lines of this form and supply a stamped envelope to the person who is making the recommendation.  Please mail this to:

Diane Cothern, 2307 Riverview Dr., Murfreesboro, TN  37129, rather than returning

it to the student.  Thank you for your cooperation.

Recommendation for: _________________________________________________ 

From:_____________________________Address:__________________________ 

Phone (Home):____________________(Office)____________________________ 

How long have you known this student?___________________________________  

In what capacity/relationship?___________________________________________ 

Indicate your assessment of the student in the following categories:  (If you do not

know, please indicate.)

Emotional Stability:

Sense of Humor:

Academic Ability:

Respect for Authority:

Ability to Work Independently:

Ability to Work With Others:

Does he/she complete tasks he/she starts?

Does this student take responsibility for his/her own actions?

Please attach a statement to describe other attributes that make this person a good

candidate for an academic program that requires a high level of cooperation,

maturity and academic independence.

Do you recommend this student as an asset to our program:___________________

Signature:_______________________________________   Date:______________