fbpx

Join us beginning June 26 for the Art and Science of Community Leadership series.    Learn More

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