Leadership Franklin County Youth is designed to provide learning opportunities to Franklin County high school sophomores during the 2018 – 2019 school year with the goal of creating a community of young people who are actively engaged in responsible, ethical and effective leadership. This program is geared to students with leadership potential who may not currently be serving in any student-oriented leadership roles. This survey should be completed by someone who is not related to the student.

It is asked that you complete this referral form for the below student, who is a current applicant to Leadership Franklin County Youth. This form must be received by February 20, 2018. 

* 1. Please enter the student's full name and school.

* 2. How long have you known this student?

* 3. In what capacity do you know this student?

* 4. What potential leadership qualities do you believe this student possesses? Examples: Self-awareness (understands own strengths and areas that need improvement), self-confidence, creativity, original thought, motivation, desire to learn, social engagement (peer interactions, engages in discussion), independence, initiative, academic ability, potential for growth.

* 5. What leadership qualities do you believe this student needs to work on?

* 6. How do you feel this student may benefit from LFCY?

* 7. How do you see this student applying leadership skills acquired in this program in the next 5 years?

* 8. Please feel free to add any additional comments that you feel will support this student’s application to Leadership Franklin County Youth.

* 9. Please provide your email so we may contact you for an additional survey after the program.

* 10. By typing my name below, I acknowledge that I understand the information provided is correct to the best of my ability.