Adelphi • Agnes Scott • Albertson • Albion • Albright • Alfred • Allegheny • American • Amherst • Antioch • Arcadia • Assumption • College of the

Atlantic • Austin College • Babson • Baldwin–Wallace • Bard • Barnard • Bates • Beloit • Bennington • Bentley • Binghamton • Birmingham–Southern • Boston College
Boston U • Bowdoin • Bradley • Brandeis • Bryant • Bryn Mawr • Bucknell • Butler • California Lutheran • Carleton • Carnegie Mellon • Case Western Reserve • Centenary (La.) • Centre • Chatham • Claremont McKenna • Clark U • Coe • Colby • Colby–Sawyer • Colgate • Colorado College • Concordia College (N.Y.)
Connecticut College • Cornell College • Cornell U • U of Dallas • Dartmouth • Davidson • U of Delaware • Denison • U of Denver • DePauw • Dickinson • Dominican U (Calif.) • Drew • Duke • Earlham • Eckerd • Elizabethtown • Elmira • Embry–Riddle • Emmanuel College (Mass.) • Emory
Eugene Lang • Fairfield • Fisk • Florida Southern • Fordham • Franklin & Marshall Furman • George Fox • George Washington • Gettysburg • Gonzaga • Goucher

TEACHER EVALUATION
Grinnell • Guilford • Gustavus Adolphus • Hamilton • Hampden–Sydney Hampshire • Hanover • Hartwick • Harvard • Harvey Mudd • Haverford
Hendrix • Hiram • Hobart & William Smith • Hofstra • Hollins • Holy Cross Hood • Ithaca • Johns Hopkins • Juniata • Kalamazoo • Kenyon • Knox
La Salle • La Verne • Lafayette • Lake Forest • Lawrence • Le Moyne • Lehigh Lesley • Lewis & Clark • Linfield • Loyola College • Loyola U (La.) • Luther
Macalester • U of Maine (Farmington) • U of Maine (Orono) • Manhattan Manhattanville • Marietta • Marlboro • Marquette • Mary Washington
McDaniel • Merrimack • U of Miami (Fla.) • Miami U (Ohio) • Middlebury Mills • Millsaps • Moravian • Morehouse • Mt Holyoke • Muhlenberg • Nazareth
New England College • U of New Hampshire • New York U • Northeastern U Notre Dame de Namur • Oberlin • Occidental • Oglethorpe • Ohio Wesleyan
Pace • U of the Pacific • Pitzer • Pomona • U of Portland • Princeton • Providence Puget Sound • Queens U (N.C.) • Randolph–Macon • Randolph–Macon Woman’s
Redlands • Reed • Regis College • Regis U • Rensselaer • Rhodes • Rice • U of Richmond • Ripon • U of Rochester • Rochester Inst of Tech • Roger Williams • Rollins • St Anselm • St Benedict & St John’s • St Joseph’s College (Me.) • St Joseph’s U • St Lawrence • St Leo • St Louis U • St Mary’s College (Calif.) • St Michael’s • St Norbert
St Olaf • St Peter’s • St Vincent • Salem (N.C.) • Salve Regina • U of San Francisco • Santa Clara • Sarah Lawrence • Scranton • Scripps • Seattle U • Sewanee • Simmons • Skidmore • Smith • Southampton • Southern Maine • Southern Methodist • Southwestern U • Spelman • Spring Hill • Stetson • Stevens Inst of Tech
Stonehill • Suffolk • Susquehanna • Swarthmore • Sweet Briar • Syracuse • U of Tampa • TCU • Transylvania • Trinity College (Conn.) • Trinity U • Tufts • Tulane • Tulsa • Union College (N.Y.) • Ursinus • Utica • Valparaiso • Vanderbilt • Vassar • U of Vermont • Wabash • Wagner • Wake Forest • Washington College
Washington U (Mo.) • Washington & Jefferson • Washington & Lee • Webster • Wellesley • Wells • Wesleyan • Westminster (Mo.) • Westminster (Pa.) • Wheaton (Mass.) • Wheelock • Whitman • Whittier • Widener • Willamette • William & Mary • William Jewell • Williams • Wilson • Wittenberg • Wofford • Wooster • WPI • Xavier (Ohio) • Yale

The member colleges and universities listed above fully support the use of this form. No distinction will be made between it and the college’s own form.
Please type or print in black ink.

TO THE APPLICANT
Fill in the information below and give this form and a stamped envelope, addressed to each college to which you are applying that requests a Teacher
Evaluation, to a teacher who has taught you an academic subject.
Birthdate Gender Social Security No.
mm/dd/yyyy (Optional)

Student Name
Last/Family First Middle (complete) Jr., etc.

Address
Number and Street City or Town State Country Zip Code or Postal Code

School you now attend CEEB/ACT code

TO THE TEACHER
The Common Application group of colleges finds candid evaluations helpful in choosing from among highly qualified candidates. We are primarily
interested in whatever you think is important about the applicant’s academic and personal qualifications for college.
Please detach along perforation

Please submit your references promptly. A photocopy of this reference form, or another reference you may have prepared on behalf of this student,
is acceptable. You are encouraged to keep the original of this form in your private files for use should the student need additional recommendations.
Please return it to the appropriate admission office(s) in the envelope(s) provided you by this student. We are grateful for your assistance. Be sure to
sign below.

Teacher’s Name (please print or type) Position

Secondary School

School Address

Teacher’s Phone ( ) Teacher’s E-mail

Area Code Number Ext.

Signature Date

BACKGROUND INFORMATION
How long have you known this student and in what context?

What are the first words that come to your mind to describe this student?

List the courses you have taught this student, noting for each the student’s year in school (10th, 11th, 12th) and the level of course difficulty
(AP, accelerated, honors, IB, elective, etc.)

2004–2005 COMMON APPLICATION ™ TEACHER EVALUATION I TE-1

EVALUATION Please write whatever you think is important about this student, including a description of academic and personal characteristics.
We are particularly interested in the candidate’s intellectual promise, motivation, maturity, integrity, independence, originality, initiative, leadership
potential, capacity for growth, special talents, enthusiasm, concern for others, respect accorded by faculty, and reaction to setbacks. We welcome
information that will help us to differentiate this student from others.

RATINGS
Compared to other college-bound students in his or her secondary school class, how do you rate this student in terms of:
Very Good One of the top
Below Good (well above Excellent Outstanding few encountered
No basis Average Average (above average) average) (top 10%) (top 5%) in my career
Creative, original thought
Motivation
Self-confidence
Independence, initiative
Intellectual ability
Academic achievement
Written expression of ideas
Effective class discussion
Disciplined work habits
Potential for growth

CONFIDENTIALITY We value your comments highly and ask that you complete this form in the knowledge that it may be retained in the student’s file should the applicant matriculate at a member
college. In accordance with the Family Educational Rights and Privacy Act of 1974, matriculating students do have access to their permanent files, which may include forms such as this one. Unless required by state
law, colleges may not provide access to admission records to applicants, those students who are denied admission, or those students who decline an offer of admission. Again, your comments are important to us
and we thank you for your cooperation. These colleges are committed to administer all educational policies and activities without discrimination on the basis of race, color, religion, national or ethnic origin, age,
handicap, or gender. The admission process at private undergraduate institutions is exempt from the federal regulation implementing Title IX of the Education Amendments of 1972.
TE-2 TEACHER EVALUATION I COMMON APPLICATION ™ 2004–2005