Teacher/Administrator Assessment

Please type or print clearly using a blue or black pen.

Applicant’s name: __________________________________________________________________________________

Name of School: ____________________________________________________________________________________ed to play. And yes, I will let my mom know that Kelly enjoyed state, we would be in a since helping out oth

Name of teacher or school administrator: ________________________________________________________________

Title and department: ________________________________________________________________________________

Telephone: _________________________________________ Fax: ___________________________________________

The student whose name appears above is applying for an achievement award for students with print disabilities (visual impairments, learning disabilities and/or physical disabilities). This award is presented by the Texas Unit of Recording for the Blind & Dyslexic^® to outstanding students in recognition of their academic accomplishments and personal achievements.

The selection committee will review your assessment of the applicant’s academic performance, abilities and personal qualities. Provide specific information about the applicant, such as: his/her talents, dedication, perseverance, achievements, or how he/she serves as a role model for other students. Please use additional sheets or attach this form to a letter.

Signature: __________________________________________________ Date: _________________________________

This form must be mailed with the candidate’s personal application and a copy of the student’s latest transcript or report card, postmarked by December 15, 2008.