La Vida Center for Outdoor Education & Leadership
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Reference Form

Thank you for taking the time to fill out the recommendation form below. The applicant is applying to work at a day camp that uses adventure education to promote character growth in middle school campers. The camp is located at Gordon College, a nondenominational Christian liberal arts college on the North Shore. Junior counselors assist staff with safety, activities and small group leadership. We appreciate your honest estimate of the applicant.

All recommendations are due: March 25, 2011

PLEASE NOTE: This form needs to be completed within 20 minutes or the page will time-out and all information will be lost. One suggestion to prevent loosing your content would be to write your thoughts in a word processor program first and then copy and paste the material into this form.

Junior Counselor Reference Form

1. Applicant's Name

2. Reference Name

3. Reference Phone Number

4. Reference E-mail

5. How long have you known the applicant?

6. How do you know him or her (in what capacity)?

7. Please rank the applicant's leadership potential.

8. Please rank the applicant's emotional maturity

9. Please rank the applicant's judgment and decision-making skills.

10. Please rank the applicant's work ethic.

11. Please rank the applicant's integrity.

12. Please rank the applicant's communication skills.

13. Please rank the applicant's ability to work with others.

14. Please rank the applicant's faith commitment.

15. Comments or clarification about your responses in questions 7-14.

16. Listed below are traits that may limit the applicant's effectiveness in some positions. Please check any traits you have observed in the applicant (presence of these traits will not automatically disqualify an applicant from a leadership position).

Argumentative
Cocky
Controlling or domineering
Easily embarrassed
Easily depressed
Easily discouraged
Easily irritated
Frequently worried, anxious or nervous
Given to exclusive and absorbing relationships
Impatient
Inflexible
Lazy
Prejudiced toward groups, races or nationalities
Withdrawn or overly quiet
Very Critical or Jokingly Critical
None Observed

17. Comments or clarification about any items you checked in question 16.

18. What are three of the applicant's strengths?

19. What are three areas in which the applicant needs further development?

20. What leadership traits does this applicant possess?

21. Based on your knowledge of the applicant, please explain how you feel that he or she would perform in a leadership position?

22. Do you recommend this individual for a position with the La Vida Adventure Camp?

Strongly recommend
Recommend
Recommend with reservations
Do not recommend

23. Additional Comments

24. Signature

25. Date Signed