Teacher Reference Form - National Geographic Student Expeditions Page 2
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25. Are you aware of any emotional, behavioral, or medical issues that may affect the applicant's ability to
be an active and constructive member of a small group of peers or a residential academic program?
6. Please comment on the likelihood that the applicant would be a constructive and positive member of a
small group of peers and leaders, who are supportive of one another and open to new experiences and
challenges.
7. Please mark the box that best describes the student’s behavior, ranging between the statement on the
left and the statement on the right. (ie: For the first question, if the student actively participates and works
well with people in group settings, you would place an X in the right-most box below).
Uncomfortable in groups – loner.
Participates actively in group settings.
Lacks self-confidence. Hesitant.
Approaches challenges with confidence.
Not comfortable with new experiences
Adapts well to new experiences and to
or with change.
changing circumstances.
Not comfortable with peers. Shy.
Comfortable with peers. Makes friends
easily.
Not respectful of peers who are outside
Treats peers outside group of friends with
group of friends.
respect and consideration.
Not willing or able to take initiative.
Takes the initiative in activities and in
problem solving.
Needs close supervision to accomplish
Can be counted on to follow through
tasks. Tends to give up.
without prompting. Perseveres.
Can’t be trusted to follow rules without
Follows rules and responds honestly to
close supervision.
authority. Trustworthy.
Lacks effective communication skills.
Able to share ideas and feelings with
peers and adults. Good communicator.
Emotionally unpredictable. Mood
Emotionally stable. Generally in a good
swings frequently.
mood.
8. If you were leading or teaching at a program such as those described on our website, would you be
eager to have the applicant in your group?
Name and Position: _________________________________________________________________________
Signature:_________________________________________________________________________________
Date:____________________ E-mail address: ___________________________________________________
Day phone:_______________________________ Evening phone:____________________________________
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