Confidential Reference Form

Halifax Independent School

Confidential Reference (Pre-Primary/Primary)

Please complete this online form at your earliest convenience. Should you have any technical difficulty with this form, please call us (902-423-9777) We would gladly arrange a time to collect your reference by phone. Thank you!

Your Info

Your Name (first and last)

Job Title/Position

Name of Daycare Centre/School

(if applicable)

Phone

If you provide your email, a copy of your responses will be emailed to you.

Thank you for helping us get to know this child.

Child's Name (first and last)

How long have you known this child?

In what capacity have you known this child?

Describe this child's current strengths.

Describe strategies that this child currently uses to handle conflict or frustration.

Describe this child's current self-help skills in the areas of eating, toileting, dressing.

Describe skills and concepts on which this child is currently working.

As of this date, how dependably does this child recognize and respond appropriately to the need to use the toilet?

Please provide any other information that you feel is important about this child.

Share your experience interacting with this child's parent(s) or guardian(s).

Do you have any experience discussing a concern or a challenging topic with this child's parent(s)/guardian(s)?

Yes

If so, please describe their participation and reaction, and your comfort level. (If not, type N/A."

Anything else?

Feel free to share anything that you consider important.

If you are human, leave this field blank.

Address and Map

3331 Connaught Avenue, Halifax, Nova Scotia, Canada B3L 3B4

Transit Options

Our school is on Metro Transit Route #29, and not far from bus stops on Route #1

School Office

Phone
1-902-423-9777

Fax
1-902-423-9555

Email Front Desk