Confidential Reference Form Page 2
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27. 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 or
Adapts well to new experiences and to
with change.
changing circumstances.
More focused on adults than on peers. Shy.
Comfortable with peers. Makes friends easily.
Puts down peers who are outside group of
Treats peers outside group of friends with
friends. Tends to be cliquey or exclusive
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 without
tasks. Tends to give up.
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 swings
Emotionally stable. Generally in a good
frequently.
mood.
8. If you were leading or teaching at a program such as those described in our catalog and on our website
( ), would you be eager to have the applicant in your group? Please explain.
9. (Language instructors for Language Learning or Excel Language Course Applicants Only):
a. For how many years have you been his/her language instructor? ____________________________
b. At what level of French/Spanish/Mandarin is the applicant currently enrolled (e.g. French 2 honors)?________
c. On a scale of 1 to 10, please rate the applicant in the following areas:
_______
Motivation for language study:
Oral proficiency:_________ Grasp of grammatical structures:
Curiosity about cultures of French, Spanish, or Mandarin speaking countries: _________
d. Please comment on the likelihood that the applicant would be committed to speaking French/Spanish/Mandarin
on this program, even with English-speaking peers, instructors, and/or native speakers:
Name and Position: _________________________________________________________________________
Signature:_________________________________________________________________________________
Date:____________________ E-mail address:
Day phone:_______________________________ Evening phone:____________________________________
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