ELITE Ambassadors Council (EAC) Referral Form Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Age Question Title * 4. Grade Level/Classification Question Title * 5. How long have you known this student? 1-3 years 3-5 years 5- 7 years 7-10 years More than 10 years Question Title * 6. Please rate the student's skills below. ( 5=highest and 1=lowest) 1 2 3 4 5 Responsibility Responsibility 1 Responsibility 2 Responsibility 3 Responsibility 4 Responsibility 5 Respect Respect 1 Respect 2 Respect 3 Respect 4 Respect 5 Leadership Leadership 1 Leadership 2 Leadership 3 Leadership 4 Leadership 5 Dependabiliity Dependabiliity 1 Dependabiliity 2 Dependabiliity 3 Dependabiliity 4 Dependabiliity 5 Cooperativeness Cooperativeness 1 Cooperativeness 2 Cooperativeness 3 Cooperativeness 4 Cooperativeness 5 Ability to work with others Ability to work with others 1 Ability to work with others 2 Ability to work with others 3 Ability to work with others 4 Ability to work with others 5 Ability to lead others Ability to lead others 1 Ability to lead others 2 Ability to lead others 3 Ability to lead others 4 Ability to lead others 5 Punctuality Punctuality 1 Punctuality 2 Punctuality 3 Punctuality 4 Punctuality 5 Initiative Initiative 1 Initiative 2 Initiative 3 Initiative 4 Initiative 5 Question Title * 7. Identify at least 3 of the students' strengths Question Title * 8. Identify at least 2 of the students' weakness. Question Title * 9. Rate your recommendation Highly Recommend Recommend as qualified Recommend with slight reservations Unable to recommend Question Title * 10. Your first name Question Title * 11. Your last name Question Title * 12. Agency/Organization/Church you represent Question Title * 13. Position Question Title * 14. Telephone number Question Title * 15. Email Address Question Title * 16. If you would like to attach an official letter of recommendation, you can upload it here. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File If you would like to attach an official letter of recommendation, you can upload it here. Question Title * 17. By typing your name below, you agree to recommend this student without any reservations. Question Title * 18. Signature confirmation date: Date / Time Date Time AM/PM - AM PM Done