BCA Childcare/Teacher Reference Form

Please complete the following information for the student applying for enrollment in Belvoir Christian Academy's Early Childhood Education program.

Student Applicant Namerequired

First Name

Last Name

Seeking admission to age level:required

Individual completing this formrequired

First Name

Last Name

Your title/relationship to student required

School/childcare where you taught/cared for the studentrequired

Phonerequired

Email required

How long have you known the child? required

Are you aware of any mental, physical, emotional or social issues that would hinder this applicant from being successful in a typical educational or childcare setting? (If yes, explain below.)required

To your knowledge, does the applicant come from a Christian home, a well-disciplined home, and/or receive encouragement at home?required

Has this student been asked to withdraw from a child care facility? If yes, explain: required

Recommendation of this child could best be described as a candidate for admission:required

With confidence

With reservation

Not recommended

APPLICANT'S CHARACTERISTICS

Please choose appropriate recommendation for the following areas.

Please add comments or concerns: