Reference Form

*Indicates Required Field

Name of Candidate
*First Name:
*Last Name:
Evaluator Information
*First Name:
*Last Name:
*Title:
*Email:
*Institution:

*Institution Address:

*City:

*State:

*Zip:

*Institution Phone: ( ) -
Institution Fax: ( ) -

*1. How do you know the candidate?
*2. How many years have you known the candidate?
*3. Please rate the candidate with respect to each characteristic listed below.
Characteristics

Exceptional
(top 5%)

Superior
(next 10%)
Average
(next 35%)
Below Average
(bottom 15%)
Leadership ability
Interpersonal skills - peers
Interpersonal skills - adults
Motivation to learn
Influence over others

*4. What characteristics do you see as the candidate's strengths and weaknesses as they relate to his or her potential for leadership in the future?
*5. What specifically would you like the candidate to take away from the Christian Leadership Institute?

Academy for Leadership Development and Community Engagement & Service

Academy for Leadership Development
One Bear Place #97370
Waco, TX 76798-7370

(254) 710-3014