Core Reference Form

Thank you for serving as a reference.

The person listed is an applicant for Leadership Lackawanna's Core Program - a 10-month community leadership and professional development program dedicated to enhancing a participant's leadership, interpersonal and managerial skills, as well as providing an improved understanding of the issues relevant to the Greater Scranton region, through monthly sessions. Applicants must live, work or play in Lackawanna County; be committed to enhancing the area's economy and quality of life; and have a desire to take on a community leadership role/position within Lackawanna County/Scranton area.

The Selection Committee attaches considerable weight to the statements made by references. We are aware of the time necessary to prepare such an assessment and gratefully acknowledge your help.

Core Program Applicant Name*

First NameLast Name

Reference Name*

First NameLast Name

Reference Company/Organization*

Reference Position/Title*

Reference Email*

example@example.com

1. How long and in what capacity have you known the applicant?*

2. What do you consider the applicant's primary talent and strength?*

4. Please comment on the applicant's leadership potential hence making them an ideal candidate.*

5. Use the scale below to evaluate the applicant.

	Above Average	Average	Below Average	Unable to Judge
Character
Concern for Others
Responsibility/Dependability
Leadership Capability
Initiative
Curiosity
Ability to work with others
Judgement
Poise
Oral Communication Skills
Persistence and Drive
Interest in Community Affairs
Creativity

Reference Signature*

Date*

Date