Your Name
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First Name
Last Name
Email
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Phone
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(###)
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Affiliated Organization
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Title
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Applicant's Name
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First Name
Last Name
How long and under what circumstances have you known the applicant?
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Describe the applicant's strengths.
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In what areas does the applicant have room for growth?
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How does the applicant interact with others from a different background?
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How does the applicant respond to directives from peers or supervisors? How does the applicant respond when he or she disagrees?
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Check All That Apply
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Comments on any tendency marked above:
Please indicate which of the statements in each pair below best describes the applicant. If you have not observed the applicant in this situation, please select unknown. *
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Please comment on any other aspects of this applicant that might be relevant.
At what level would you recommend this applicant for acceptance into Living and Learning?
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Weak, should be discouraged
Average, no major red-flags but doesn't appear to excel
Good, better than many
Very good, no reservation at all
By typing my full name below, I attest that the information that I provided is complete and accurate to the
best of my knowledge.
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