Teacher Reference Reference Name* Reference for...* How long have you known the applicant and in what capacity? Did you know the application was applying to be a mentor? Yes No If so, what was your reaction? What personal strengths do you feel the applicant has to offer?Can the applicant be counted on to follow through on the commitments he/she undertakes? Yes No To your knowledge, has the applicant ever had any trouble following the rules? Yes No If so, what kind of rules? Would you recommend the applicant as a mentor for a child or youth? Yes No Is there anything else you would like to add that would aid us in our decision?Flexibility Extremely Good Very Good Somewhat Good Poor Extremely Poor Please rate the student on the following characteristic.Ability to accept feedback Extremely Good Very Good Somewhat Good Poor Extremely Poor Please rate the student on the following characteristic.Maturity Extremely Good Very Good Somewhat Good Poor Extremely Poor Please rate the student on the following characteristic.Ability to manage time well Extremely Good Very Good Somewhat Good Poor Extremely Poor Please rate the student on the following characteristic.Ability to get along with others. Extremely Good Very Good Somewhat Good Poor Extremely Poor Please rate the student on the following characteristic.Attentive Extremely Good Very Good Somewhat Good Poor Extremely Poor Please rate the student on the following characteristic.Ability to be on time Extremely Good Very Good Somewhat Good Poor Extremely Poor Please rate the student on the following characteristic.Ability to work unsupervised Extremely Good Very Good Somewhat Good Poor Extremely Poor Please rate the student on the following characteristic.Please comment on any "Poor" ratings from the above questions.CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Facebook Twitter Google+ LinkedIn
