COLUMBIA INTERNATIONAL SCHOOL
153 Matsugo, Tokorozawa, Saitama 359-0027 Japan+81-42-946-1911(TEL) +81-42-946-1955(FAX)
E-MAIL: office@columbia-ca.co.jp

CONFIDENTIAL ADVISOR RECOMMENDATIONINTERNATIONAL STUDENT APPLICATIONName of student

Grade applying to:

TO THE STUDENT: Please print or type your name and grade on the line above and give this form toyour homeroom teacher, guidance counselor, advisor, Headmaster, or Principal. The person completing
this form should mail it directly to Columbia International School.
TO THE REFERENT: The above-named student is an applicant for admission to Columbia International
School. We would greatly appreciate your thoughtful comments to the questions below. Please return
this form at your earliest convenience to the admissions office at Columbia International School using theaddress at the top of this page. Thank you or your assistance.
1. How long have you known the student and what is your relationship?
____________________________________________________________________________________________________________________________________________________________________________
2. What is the proportion of students receiving similar academic evaluation results as applicant last year?
51015

20

25

30

5070％

3. Please rate the student in the following areas using the scale below:
1= Unacceptable 2=
A.
B.
C.
D.
E.

Below Average 3=

Work ethics/motivation
Honesty and integrity
Maturity
Responsibility for actions
Concern for others

Average 4= Good111
11222223333
35= Superior
4444455555

F.
G.
H.
I.
J.
K.
L.

Leadership ability
Relationships with peers
Relationships with adults
Reactions to suggestions and advice
Reactions to criticism
Ability to meet commitments
Please elaborate on any rating(s) below 3

1
1
1
1
1
12
2
2
22
23
3
3
3
3
3

4
4
4
4
4
4

55
5
5
5
5

____________________________________________________________________________________________________________________________________________________________________________
4. How many students are there in your school and in applicant’s grade? ___________________________
5. What do you perceive as the student's greatest strength?
____________________________________________________________________________________________________________________________________________________________________________
6. What do you perceive as the student's greatest need?
____________________________________________________________________________________________________________________________________________________________________________
7. Please discuss the student's participation in community, athletic, or other extracurricular activities.
____________________________________________________________________________________________________________________________________________________________________________
8. Has the student ever been in any disciplinary difficulty that you are aware of? Please relate theincident(s) and any disciplinary action that resulted.
____________________________________________________________________________________________________________________________________________________________________________
9. What are the student's reasons for attending school in your country?
____________________________________________________________________________________________________________________________________________________________________________
10. Additional comments which might be helpful for his/her admission to Columbia International School.
____________________________________________________________________________________________________________________________________________________________________________
Date:_______________

School/Position: ________________________________________________________________________
Address:________________________________________________________________________

Phone:_______________________________

Signature:_______________________________________

Fax:_______________________________