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1-765-641-3863

Student Recommendation Form

Thank you for agreeing to recommend a student for the Youth Leadership Academy of Madison County. This reference relates to the student’s character, ability, leadership potential and involvement in the overall community.

Your reply is considered strictly confidential. If you would prefer to talk with someone about this information, call 765-641-4050.


Your Information
Name*
Please let us know your name.
Email*
Please let us know your email address.
Address*
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Zip*
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Phone Number*
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Student Information
Student's Name*
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High School Attending*
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Grade*
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How long have you known this student?*
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In what capacity? (friend, teacher, principal, etc.)*
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Please compare the student to his or her peer group
Overall attitude toward school or agency*
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Attendance (at school or agency)*
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Cooperation with others*
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Dependability*
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Effectively communicates with others*
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Ability to take initiative/self motivated*
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Flexible/adapts as needed to situations*
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Integrity*
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Judgement and common sense*
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Maturity for his or her age*
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Participation in extracurricular school activities*
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Leadership in extracurricular school activities*
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Participation in civic activities*
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Leadership in civic activities*
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Write a short statement related to the leadership traits you currently observe in this student or the potential you believe this student possesses.*
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For Youth Leadership Academy of Madison County, I can recommend this student:*
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My reservations include
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