Teacher/Counselor/Administrator Form – Seldovia Village Tribe

Teacher/Counselor/Administrator Form

Student's Name *

First

Last

Teacher/Counselor/Administrator Name *

First

Last

How long have you known this student? *

What is your role? *

(Counselor, Principal, Teacher)

This student demonstrates respect for authority, peers, property. *

This student acts cooperatively. *

This student has a history of inappropriate behavior. *

This student has a history of alcohol or drug use. *

This student has a supportive family/network. *

1. What are this student’s strengths? *

2. What are this student’s weaknesses? *

3. Do you have any concerns about this student’s participation in camp? *

4. What do you hope this applicant will most benefit from by attending camp? *

5. Other comments

Teacher/Counselor/Administrator Signature *

Date *

Name *

First

Last

School *

Title *

Phone *

Email *

Email

Confirm Email

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