CONFIDENTIAL

ABA Student Reference

To be completed by a current administrator, teacher or school counselor. We have received an application for
the following student to join ABA. In order to assist in the admissions process, we would appreciate if you
would complete this form and return it to the school by email: registrar@abaoman.org or fax
(+968)24603544.

Student name: Zaki Muhammad Husni Current Grade: Grade XI

Current school: SMA Pesantren Unggul Albayan Anyer School Website: www.albayananyer.sch.id

Address: Jalan Raya Anyer Karang Bolong KM 133,7. Bandulu. District of Anyer, Serang Regency, 42166 Country:

Indonesia_____ Telephone: (0254) 8495099 Is English the language of instruction? Yes

Recommender name: Raditya Muttaqin S, M.Pd Recommender position: English Teacher

Recommender email: muttaqinraditya@gmail.com

I have known this student for 1 year. Dates the student attended this school: from July 2022 to July 2023

Is English the student’s first language?  Yes ✓ No

Is English the language used at home?  Yes ✓ No

In what other languages is the student proficient? ?

Working Working Working

Please rate the student’s current progress in the Area of towards within above Not
following areas: concern expected expected expected applicable
levels levels levels
Attendance ✓

Communication: listening, receptive language ✓

Communication: speaking, expressive language ✓

Social skills: participates in large and small groups ✓

Writing conventions ✓

Writing content - ideas ✓

Reading fluency ✓

Reading comprehension ✓

Mathematical understanding ✓

Mathematical computation ✓

Social skills: participates in large and small groups ✓

Social skills: works with others, tolerant of differences ✓

Self-management: able to organize self and belongings ✓

Self-management: tackles new tasks confidently ✓

Thinking Skills: shares ideas and opinions ✓

Thinking skills: shows initiative, asks questions ✓

 Yes - No – No –
Has the student received any of the following support while at your
received at but may does
school?
our school benefit not
need
Support in learning English language ✓
Frequent 1-1 support to access the curriculum ✓
Frequent 1-1 support to behave appropriately in the classroom ✓
Significant differentiation of the curriculum in their current grade ✓

Please indicate any particular areas of strength:

Muhammad Dzaki Husni has some strength in academic field and worship as the spiritual aspect. For
instance; Language and science subject. Also has a very good habit, morality, character, and attitude that
to be implemented in the society.
Please indicate any particular areas for development:

Some school subjects such as Math and other science field.

Please describe parental involvement and support:

Our parental involvement and support have already been given to Dzaki, we have provided his necessity
in the academic and spiritual area, etc. We always give him the best counseling for his better output or
goals of study.

Does the student have any limitations, disabilities or special needs?  Yes ✓ No
If yes, please describe, including amount of teacher support required:

Have there ever been any concerns around Child Protection?  Yes ✓ No
If yes, please provide name and telephone number for someone who can share details confidentially:

Does the student ever disrupt the learning of others in the classroom?  Yes ✓ No
To your knowledge, has the student had any formal external assessment?  Yes ✓ No

 Speech and Language  Educational Psychologist  Occupational Therapist  Other:

Please attach any copies of external reports, as well as any internal support plans, goal-setting or learning plans.

Any further information which may be of use in placing this student in our school, eg; achievements, special
talents, family circumstances, well-being, medical conditions.
Muhammad Dzaki Husni is always have a good struggle in learning process. He obeyed to teachers’
instruction and school regulation. He is a discipline student.

Teacher Signature: Raditya Muttaqin S, M.Pd Date: 23rd August 2023

Principal Signature: Deden Ramdani, M.Pd Date: 23rd August

School Stamp: