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BSAMUN
Firefly
Junior School Reference
Form
Step
1
of
5
20%
Child's Name
*
First
Last
Child's Date of Birth
*
Name of child's current school
*
Address of child's current school
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Current year group
Dates of enrolment at current school
*
Language
Reading Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Reading Effort
*
Exceptional
Good
More effort required
Not applicable
Writing Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Writing Effort
*
Exceptional
Good
More effort required
Not applicable
Listening Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Listening Effort
*
Exceptional
Good
More effort required
Not applicable
Speaking Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Speaking Effort
*
Exceptional
Good
More effort required
Not applicable
Please provide details of additional support provided
*
Select the option that describe the pupil's reading level
*
Pictures only
Picture storybooks
Simple chapter books
Chapter books
Share the title and author and/or a Reading Scheme and level of a book recently read.
*
Mathematics
Number Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Number Effort
*
Exceptional
Good
More effort required
Not applicable
Pattern Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Pattern Effort
*
Exceptional
Good
More effort required
Not applicable
Shape and Space Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Shape and Space Effort
*
Exceptional
Good
More effort required
Not applicable
Data Handling Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Data Handling Effort
*
Exceptional
Good
More effort required
Not applicable
Problem Solving Performance
*
Consistently meets expectation
Meets expectation
Does not meet expectation
Requires additional support
Problem Solving Effort
*
Exceptional
Good
More effort required
Not applicable
Please provide details of additional support provided
*
Personal
Works Independently
*
Excellent
Good
Satisfactory
Improvement needed
Not applicable
Follows Directions
*
Excellent
Good
Satisfactory
Improvement needed
Not applicable
Communicates well with adults
*
Excellent
Good
Satisfactory
Improvement needed
Not applicable
Communicates well with peers
*
Excellent
Good
Satisfactory
Improvement needed
Not applicable
Works well in a group situation
*
Excellent
Good
Satisfactory
Improvement needed
Not applicable
Completes work on time
*
Excellent
Good
Satisfactory
Improvement needed
Not applicable
What does the child particularly enjoy?
*
Has the child ever been recommended for/received extra support?
*
Yes
No
If yes, please explain and include IEPs where appropriate.
*
Please note any concerns, personal, academic, behavioural, you have about this child.
Please note any additional comments you wish to make.
Referee Details
Name of referee
*
First
Last
Position held
*
Email
*
Phone
Δ
