Salisbury Youth Council Recommendation Form

Leadership Ability *

	1	2	3	4	5

1 is Unsatisfactory, 5 is Exceeds Expectations

Ability to balance school and Salisbury Youth Council *

	1	2	3	4	5

1 is Unsatisfactory, 5 is Exceeds Expectations

Level of respect *

	1	2	3	4	5

1 is Unsatisfactory, 5 is Exceeds Expectations

Level of cooperation *

	1	2	3	4	5

1 is Unsatisfactory, 5 is Exceeds Expectations

Punctuality *

	1	2	3	4	5

1 is Unsatisfactory, 5 is Exceeds Expectations

Please indicate any additional comments that would assist in the selection process: *
Please provide us with your contact information:
Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
Should be Empty: