Teacher Recommendation Form: Belize Trip 2022

To whom it may concern:

During February Break, 2022, we will be taking a group of 18-27 students to Belize for a
science- and history-oriented field trip. As many students are applying to travel, some of
whom I have little or no contact with in the classroom setting or outside of school, I have
asked students to obtain 2 teacher references to assist in my selecting students who will
travel as a part of our group. I understand that this is a very busy time of year for
teachers, so I have done my best to make this a form that is easy to fill out. Please take
the time to fill this out completely and honestly.

If you do not feel comfortable writing your comments on this form, please do not hesitate
to contact me by coming to see me in room 2118, contacting me at
bgnacik@fmschools.org, or by calling the science office at 692-1838. All responses will
be kept confidential, and no information about these will be shared with any of the
applicants.

Please return this form to Ben Gnacik (HS 2) by district mail as quickly as possible
to allow me to make decisions regarding our trip in a timely manner.

Thank you very much for your time.

Sincerely,

Benjamin Gnacik
Student’s Name: ____________________ Teacher’s Name______________________

Subject Taught: ______________________

Please rate the following statements 1-5, with 1 being strongly disagree and 5 being
strongly agree. If you would like, there is space below to explain any answers you would
like to expand on.

1) Student shows interest in academics and a high level of understanding 1 2 3 4 5

in my course.
2) Student is polite and attentive in class. 1 2 3 4 5
3) Student takes responsibility for his/her actions. 1 2 3 4 5
4) Student is trustworthy and shows good decision-making abilities. 1 2 3 4 5
5) Student is polite to teacher and other students in class. 1 2 3 4 5
6) I would trust this student to make the right decisions outside of school, 1 2 3 4 5
and would not expect to have behavioral problems with this student on a
trip.
7) I would trust this student to represent FM well. 1 2 3 4 5
8) Student is responsible for his/her classwork and has homework done 1 2 3 4 5
and in school when it is due.
9) Student has permission slips signed and in on time (if applicable) 1 2 3 4 5
10) Student works well independently in class. 1 2 3 4 5
11) Student follows instructions well. 1 2 3 4 5
12) Student is mature for his/her age. 1 2 3 4 5
13) Student is a positive role model in class, school, and his/her 1 2 3 4 5
community (to the best of your knowledge)
14 This student will benefit from a learning experience outside of the 1 2 3 4 5
classroom.
15) I would recommend this student to travel to Belize with his/her peers. 1 2 3 4 5

If you would like to explain any of your answers above, please do so in the space below.

Is there anything else you would like to tell us about this student?

Thank you very much for your time! I really appreciate it!