Contact Summary Form
To be completed by the RBTV Advisor after each engagement with an applicant. Note: Additional sections are to be completed if an essay or report card have been collected during the meeting.
Applicant Full Name
First Name
Last Name
RBTV Advisor
First Name
Last Name
If first meeting, indicate the best method to contact the Applicant and the Applicant's Parent/Guardian.
Home Phone
Mobile Phone
E-mail
Facebook
Date/Time of this meeting:
-
Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Method
In-person
Phone
Video Chat
Other
Highlights of topics covered by RBTV Advisor:
Highlights of topics dicussed by Applicant:
What was the level of the Applicant's participation?
Actively participated in the conversation by answering questions fully and asking questions
Answered all questions but asked few or no questions
Asked questions but did not provide full answers to questions asked
Did not actively participate
How do you think the meeting went?
1
2
3
4
5
Difficult
Very Well
1 is Difficult, 5 is Very Well
Scores of "1" require comment:
What is your impression of the Applicant to date?
Other Comments (If applicable)
Follow-up items or topics for the next meeting:
Report Card (if collected)
Math
Please Select
A+
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
F
N/A
English/Lit
Please Select
A+
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
F
N/A
Science
Please Select
A+
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
F
N/A
Physical Education
Please Select
A+
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
F
N/A
Humanities/Social Science
Please Select
A+
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
F
N/A
Other
Please Select
A+
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
F
N/A
Other
Please Select
A+
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
F
N/A
Other
Please Select
A+
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
F
N/A
If the information is available to you, what is the general impression that teachers have of him?
Essay (If collected)
Topic
Reflect understanding of the topic:
Yes
No
Submitted on time? If not, provide explanation:
Level of Effort
1
2
3
4
5
Min
Max
1 is Min, 5 is Max
Your assessment
Date/Time of next meeting:
-
Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: