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 NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

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