* 1. Name of candidate:

* 2. Your name:

* 3. Your relationship to candidate:

* 4. If you checked "Living Area Peer" above, please indicate where you live:

* 5. How long have you known candidate:

* 6. Comment briefly on the depth of your relationship to the candidate:

* 7. Please indicate your assessment of the following qualities/strengths:

  Potential Concern Average Above Average Truly Exceptional (stands out from peers) N/A
Consideration of others
Integrity
Flexibility
Awareness
Encouragement
Trustworthy
Role model
Uses good judgment
Effective communicator
Good listener
Team player
Fairness
Creativity
Empathy

* 8. Other observations about their strengths:

* 9. Please comment on the candidate's challenges/weaknesses:

* 10. Describe how you have seen the candidate interact with others in a group.

* 11. Based on your observations, how willing is the candidate to receive and change behavior based on instruction/feedback?

* 12. Would you want this candidate to be your RA/AAC? Why or why not?

* 13. Recommend this candidate?

* 14. Anything else you would like to share or need to share about this candidate?

* 15. Your signature:

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