INTERNATIONAL HOMESTAY
APPLICATION
CONFIDENTIAL MATH
REFERENCE
You have been named as one who is able to assess the student's (applicant) academic ability as well as provide information
concerning personality and character traits. Please evaluate the applicant as objectively and thoroughly as possible. Thank
you for completing this reference form. Additional information may be provided on a separate sheet of paper if desired.
Student Name (Applicant)
Duration of Instruction
Grade Level of Student During Instruction
Based on the following scale, please score the applicant's ability in the areas listed below by placing the
corresponding number in the blanks provided.
1 = Superior
2 = Above Grade Level
3 = Grade Level
4 = Below Grade Level
5 = Very Poor
6 = Not Studied Yet
ALGEBRA I CONCEPTS
_____ Able to graph lines
Able to solve:
_____ Able to determine the slope of a line
_____ Linear equations in one variable
_____ Able to find domain & range of a function
_____ Quadratic equations by using factoring
_____ Quadratic equations using quadratic formula
Able to add, subtract, multiply, and divide:
_____ Quadratic equations by completing the square
_____ Integers (signed numbers)
_____ Inequalities (linear & quadratic)
_____ Polynomials
_____ Systems of linear equations (elimination, subtraction, & graphing)
_____ Radical expressions
_____ Rational equations and inequalities
_____ Fractions
_____ Radical equations
ALGEBRA II CONCEPTS
_____ Able to find trig ratios & use unit circle
Able to solve:
_____ Able to graph conic sections
_____ Exponential equations
_____ Able to graph functions of various types
_____ Logarithmic equations
_____ Systems of quadratic equations
Able to add, subtract, multiply, and divide:
_____ Rational expressions
_____ Complex numbers
_____ Systems of linear equations using determinants
_____ Sequences and series problems
_____ Trigonometric equations
_____ Probability problems
GEOMETRY CONCEPTS
_____ Able to apply principles of trigonometry
_____ Able to find unknown angles formed by two parallel lines cut by a transversal
_____ Able to know and use properties of the different types of quadrilaterals
_____ Able to prove two triangles congruent (SAS, ASA, SSS, HL, AAS)
_____ Able to find unknown angles and chords in a circle using circle theorems
_____ Able to find the area and volume of basis geometric shapes
_____ Able to construct a 2-column proof
_____ Able to use logical reasoning skills (converse, inverse, etc.)
_____ Able to prove and use similarity
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Please check the appropriate answers below. You may check more than one if applicable.
Areas
Home Background
Home Discipline
Obedience
Emotional Stability
Industry
Sociability
Judgment
Responsibility
Personal
Appearance
Homework
Parental
Involvement
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Rating
Superior 
Good 
Fair 
Poor

Balanced

Too much


Inconsistent 
Too little
Responds well to authority


Usually obedient

Resents authority

Unpredictable
Stable


Usually well-controlled

Excitable; moody; upsets others

Apathetic; irresponsible
Hard worker


Good dependable worker

Works just enough to get by

Lazy; needs constant supervision
Prefers to spend time with others


Prefers to be solitary

Cooperates reasonably

Has difficulty relating to others

Tends to be bossy; argumentative
Unusual maturity


Average common sense

Showing improvement

Often demonstrates poor judgment
Excellent; volunteers for tasks


Usually accepts when asked

Avoids when possible

Often irresponsible
Well groomed along conservative lines


Well groomed following newer styles

Neglects appearance
Assignments always on time and done well


Assignments occasionally late or disorderly

Assignments often not completed

Assignments seldom done adequately
Eagerly seek to be involved


Must be contacted to encourage involvement

Always cooperative and supportive

Often defensive and unsupportive

Have remained uninvolved
Comments
What do you consider the major strengths of the student?
What do you consider the major weaknesses of the student?
Indicate any special awards, honors, or achievements the student has received in math.
Does the student demonstrate the ability to adapt well to various cultures? 
Yes 
No Please explain.
Do you have any reservations concerning the student's honesty? 
Yes 
No If yes, please explain.
Do you have any reservations concerning the student's integrity? 
Yes 
No If yes, please explain.
Southside Christian School is a Christian, co-educational, college-preparatory school. Please check your
recommendation below:

Recommend without reservation

Recommend hesitantly

Do not recommend
NAME
TITLE
ADDRESS
SIGNATURE
DATE
Please return the completed form to:
Carla Evans
Southside Christian School
2211 Woodruff Road
Simpsonville, SC 29681
ks 1.9.2017
Phone: (864) 234-7575, Ext. 1258
Fax: (864) 234-7048
Email: [email protected]
Web: www.southsidechristian.org