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. 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