This form is for references of YLM applicants only.

This form is for references of YLM applicants in order to provide information regarding the applicant's leadership potential. References should NOT be a relative of the applicant. If you have any questions about YLM or the application process, please contact Mobile United Programs Director Chris Gibson at 432-1638.

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* 1. Applicant First and Last Name

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* 2. Applicant School and Grade

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* 3. Your Name

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* 4. Your Business/Organization Name

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* 5. Title/Position

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* 6. Phone Number

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* 7. For how long and in what capacity have you known the applicant?

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* 8. What do you consider the applicant's primary talents or strengths?

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* 9. Describe how this applicant has demonstrated leadership potential in activities, organizations, and/or character building.

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* 10. Additional Comments:

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