UVA Health Jr. Volunteer TEACHER Recommendation

UVA Health

Junior Volunteer Teacher Recommendation

Participation in the Junior Volunteer Program requires a high level of maturity, responsibility and commitment.

Students must be able to follow instructions and work independently.

Students are accepted based on their application, teacher recommendations, interview and space available in the program.

Please take the time to evaluate this student by thoughtfully and accurately filling in the information below.

We appreciate your honest evaluation and assessment of the applicant as well as your insight about the student's maturity.

Your responses will remain confidential and will not be shared with the student.

Student/Junior Volunteer Applicant Information:

Student's First Name: *

Student's Last Name: *

Today's date: * +

How long have you known this student? *

Teacher/Evaluator:

Teacher: *

School: *

Subject taught: *

Please rank this student in the following areas: *

	Always	Usually	Frequently	Rarely	No Opportunity to Observe
CONDUCT: The student is punctual and follows school and class rules.	Always	Usually	Frequently	Rarely	No Opportunity to Observe
COOPERATION: The student works well with peers and teachers.	Always	Usually	Frequently	Rarely	No Opportunity to Observe
DEPENDABILITY: I can depend on this student to complete assigned tasks without prompting.	Always	Usually	Frequently	Rarely	No Opportunity to Observe
RESPONSIBILITY: The student accepts responsibility for his/her work and behavior.	Always	Usually	Frequently	Rarely	No Opportunity to Observe
ATTENTION: The student listens and follows instructions.	Always	Usually	Frequently	Rarely	No Opportunity to Observe
COMMUNICATION: The student speaks clearly and effectively.	Always	Usually	Frequently	Rarely	No Opportunity to Observe
INITIATIVE: The student is resourceful and self-reliant in dealing with new situations.	Always	Usually	Frequently	Rarely	No Opportunity to Observe
COURTESY: The student shows respect for adults and authority figures, accepts supervision and treats others with kindness.	Always	Usually	Frequently	Rarely	No Opportunity to Observe
MATURITY: This student acts maturely around both peers and adults.	Always	Usually	Frequently	Rarely	No Opportunity to Observe

If you were a patient or employee at a UVA Health facility, would you like this student assigned to your area? *

Does this student maintain a neat appearance? *

To your knowledge, has this student been subject to any significant disciplinary action? Please read question carefully, then answer. *

What, if anything, distinguishes this student from others? *

Please mention anything else that you feel is relevant to this evaluation. *

Your name: *

Email: *

Phone: *

TEACHER - once you answer the final question below and click the submit button, you will receive an automatic reply email with a copy of the answers you submitted. Please check your email as we want to be sure that you are the one completing this form. If it does not come to your regular inbox, please check your SPAM or CLUTTER folder. Thank you for taking the time to complete this questionnaire. Your input is appreciated!

I certify that I am the teacher listed above. *

If you have any questions, please contact:

UVACHVolunteer@uvahealth.org * 703-369-8173