Student's Name:                _____________________________________________________

Name, School Address and Telephone Number (home or work) of Respondent:

            ____________________________________________________________

            ____________________________________________________________

            ____________________________________________________________

            ____________________________________________________________

How long you have known the above student:__________________________

Mathematics course(s) the above student took from you:

             ________________________________________________________________________

On the back of this form or on a separate sheet of paper, please describe the abilities and level of interest in mathematics of the above student.  Please also explain how the above student would benefit from a summer program in mathematics.

                    Signature:_____________________________________     Date:___________________
 

Please return by May 1 to the address listed below or fax to (919) 760-8141.

Office of Community Outreach
Meredith College
3800 Hillsborough Street
Raleigh, NC 27607-5298