~Student Leader/Teacher Character Reference For Youth Advisory Council Applicants 2016-2017~ Youth Advisory Council Reference Form Question Title This is the Student Leader/Teacher character reference survey for the 2016-2017 YAC year. To complete this reference you must be a leader of a student organization (NHS President, Thespian Society President, FBLA President, etc.), teacher, or non-family member adult. Questions: email YAC@loudoun.gov Question Title * 1. Reference's Name (First and Last) Question Title * 2. Reference's Email Address (double check for typos) Question Title * 3. Reference's Phone Number (Format XXX-XXX-XXXX) Question Title * 4. YAC Applicant's Name (First and Last of whom you are providing character reference) Question Title * 5. Relationship to YAC applicant? Question Title * 6. How long have you know the YAC applicant? Question Title * 7. Please evaluate the YAC applicant based on the following characteristics No Knowledge or N/A Poor Average Above Average Exceptional Intellectual Ability Intellectual Ability No Knowledge or N/A Intellectual Ability Poor Intellectual Ability Average Intellectual Ability Above Average Intellectual Ability Exceptional Efficient Work Habits Efficient Work Habits No Knowledge or N/A Efficient Work Habits Poor Efficient Work Habits Average Efficient Work Habits Above Average Efficient Work Habits Exceptional Leadership Skills Leadership Skills No Knowledge or N/A Leadership Skills Poor Leadership Skills Average Leadership Skills Above Average Leadership Skills Exceptional Teamwork Skills Teamwork Skills No Knowledge or N/A Teamwork Skills Poor Teamwork Skills Average Teamwork Skills Above Average Teamwork Skills Exceptional Work Ethic Work Ethic No Knowledge or N/A Work Ethic Poor Work Ethic Average Work Ethic Above Average Work Ethic Exceptional Concern for Others Concern for Others No Knowledge or N/A Concern for Others Poor Concern for Others Average Concern for Others Above Average Concern for Others Exceptional Dependability Dependability No Knowledge or N/A Dependability Poor Dependability Average Dependability Above Average Dependability Exceptional Trustworthyness Trustworthyness No Knowledge or N/A Trustworthyness Poor Trustworthyness Average Trustworthyness Above Average Trustworthyness Exceptional Eager to Learn Eager to Learn No Knowledge or N/A Eager to Learn Poor Eager to Learn Average Eager to Learn Above Average Eager to Learn Exceptional Reaction to Stressful Situations Reaction to Stressful Situations No Knowledge or N/A Reaction to Stressful Situations Poor Reaction to Stressful Situations Average Reaction to Stressful Situations Above Average Reaction to Stressful Situations Exceptional Integrity Integrity No Knowledge or N/A Integrity Poor Integrity Average Integrity Above Average Integrity Exceptional Motovation Motovation No Knowledge or N/A Motovation Poor Motovation Average Motovation Above Average Motovation Exceptional Potential for Growth Potential for Growth No Knowledge or N/A Potential for Growth Poor Potential for Growth Average Potential for Growth Above Average Potential for Growth Exceptional Question Title * 8. What do you admire most about the YAC Applicant? (this can be short) By clicking submit below you are agreeing that the information in the above character reference survey is accurate, changes cannot be made after submission. Questions? Feel free to reach out to Youth Initiative Specialist, Alex Beard! YAC@loudoun.gov or (703)737-8335 Submit to Loudoun County PRCS
