International Christian School

Student Reference Form

Secondary School

To Administrator, Current Homeroom Teacher, or Counselor:

The below named student has applied for admission to International Christian School. This reference is an
important part of the application and your cooperation in providing a full and candid report will be greatly
appreciated. All information shared will be kept confidential. Please return the completed and signed form
electronically by email to (admissions@ics.edu.hk) or in a sealed envelope directly to:

Admissions Office
International Christian School
1 On Muk Lane, Shatin, New Territories, Hong Kong
admissions@ics.edu.hk Tel: (852) 3920 0001 Fax: (852) 2336 6114 ics.edu.hk

Full Name of Applicant

________________________________________________________________

Date of Birth ___________________________ Applying Grade ___________________

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1. In what capacity have you known this student and for how long?
___________________________________________________________________________
___________________________________________________________________________

2. Do you currently teach this student?

Yes
No

For each area listed below, please select the option that best describes the student
Below
Academic Performance Excellent Good Average
Average
Poor

Reading Comprehension Skills

English Proficiency
Writing Skills
Math Skills
Below
Work Habits Excellent Good Average
Average
Poor

Attention to Task
Organizational Skills
Ability to Work Independently
Cooperation in Group Activities
Completion of Assignments on Time
School Attendance
Self-motivation and Effort
Below
Personal & Relational Characteristics Excellent Good Average
Average
Poor

Honesty and Integrity

Level of Self-esteem and Confidence
Ability to Exercise Self-control
Respect for Others
Positive Relationships with Peers
Emotional Stability

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ICS Admissions - Student Reference (June 2021)
 3. Please briefly comment on the student’s strengths and weaknesses.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

4. Attitude of Parents:
Cooperative
Uninvolved
Overly Protective
Aggressive/ Insistent
No basis for judgement

Please indicate the level of parental support from 0 (not supportive at all) to 10 (very supportive):

0 1 2 3 4 5 6 7 8 9 10

5. Please indicate if the student has been involved in the following activities:

Cheating on test, quiz or assignment Fighting with another student or students

Verbal threats, profanity and filthy language Sexual harassment
Possession or use of alcohol or illegal drugs Attempted or actual theft of and or damage
on campus to property

6. Has the student ever been suspended or dismissed from school for disciplinary reasons or criminal
misconduct?
Yes No If yes, please explain
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

7. Is this student in good standing and eligible to re-enroll in your school in the next grade level?

Yes No If no, please explain

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

8. Has the student been recommended for or is currently receiving support services (e.g. special
education, counseling, ELL, etc.)?

Yes No Please explain.

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

9. Additional Comments that may help the school to assess the educational needs of the student:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

10. Would you be willing to provide further information when needed?

Yes No

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ICS Admissions - Student Reference (June 2021)
Referrer and School Information

___________________________ ___________________________

First Name of Referrer Last Name of Referrer

___________________________ ___________________________

Signature of Referrer Date

___________________________ ________________________________________________________

Position School Name

_____________________________________________________________________________________

School Address

___________________________ ______________________________________________________

School City School Country & Postal Code

___________________________ ___________________________

Telephone Number Email Address

Thank you for your time and cooperation. Our goal is to support this child’s transition and determine success
in our school. Please be assured that this information will not be shared with the applicant’s parents. If you
have any questions, please contact our office. Thank you again for your willingness to help!

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ICS Admissions - Student Reference (June 2021)