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					                Bishop Ludden Jr Sr High School *815 Fay Road * Syracuse, New York 13219 * 315.468.2591       E
                                   MUST BE COMPLETED BY TEACHER
     Please return this form in the enclosed sealed Bishop Ludden envelope with your signature on the seal.
             This form is necessary to complete an application to Bishop Ludden Jr/Sr High School.


Student __________________________________________ in Grade __________

For the 2009-2010 School Year at _______________________________________

GENERAL:        (Please check all that apply)
Classroom:      ___ works well independently         ___ needs teacher guidance     ___ lacks organizational skills
                ___ works well with others           ___ impulsive behavior sometimes impacts classroom performance
Instruction:    Attentive ___always ___sometimes ___easily distracted ___has difficulty sitting still and focusing
                Participates ___always ___sometimes ___never
                Follows 2-3 step directions: ___always ___sometimes ___never
Homework:       ___done ___incomplete ___on time ___late ___usually not done ___receives parental guidance
Attendance:     ___good ___poor attendance hinders academic progress ___has difficulty making up work from absences

SPECIAL NEEDS: (Please check all that apply)
Student currently participates in:
___CAI in Math              ___CAI in Reading             (These programs are not available at Bishop Ludden)
___Resource Program
___Student currently has an IEP or 504 Plan (Please attach a current copy)
___Student does not have an IEP, but is receiving the following services:______________________________
___Student is currently being evaluated.

                  Please indicate student’s 4th or 8th Grade (most recent standardized test scores)

          ELA          1         2         3         4          Math          1          2         3       4

Please feel free to add any additional comments on the back of this form. If there is anything you feel our
Admissions Board should be aware of to help this student achieve to the best of his/her ability, please jot down
or call Sr. Marcia Barry at 488-3237. We appreciate your cooperation.

Signature of teacher completing this survey:__________________________________ Date_______________

Print name of teacher completing this survey:____________________________________________________

 For all students, please attach a copy of the current 2009-2010 report card. For students in grades 9-11, please
                             include a copy of school transcript and current report card.

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