Youth Delegate Reference Form

CISV DFW Youth Delegate Reference Form
The following is a recommendation for First Name Last Name, a youth applicant for a CISV program.
The youth is applying for (please select one):

Village (peace education camp for 11 year olds)Youth Meeting (peace education camp for 12-13 year olds)Step Up (peace education camp for 14 year olds)
If selected, the youth applicant will represent both the United States and his/her own area in an international setting. The local CISV USA Chapter requests your help in identifying applicants who exhibit leadership qualities and can represent their own culture successfully.

This form must be completed no later than Friday, January 10, 2025.

If you have any questions about this form, please email CISV DFW at dfw@cisvusa.org.
Reference Information
Name

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.
Email
example@example.com
Capacity in which you know the applicant:
If you are the youth applicant’s current teacher, what is your school’s name?
Length of time you have known the youth applicant:
Please check all the traits in the list below that you consider to be characteristic of the youth applicant:

MatureIndependentResponsibleExpressiveAcceptingDiscerningShows initiativeOptimisticPessimisticResponsiveCooperativeCautiousCuriousAttentivePracticalHelpfulParticipatesNeeds coaxingCaringSpontaneousReticentOpen-mindedRespects adultsRespects peersFollowerLeaderTeam playerFair-mindedOrganizedDependentCreativeQuietSecureVivaciousSensitiveForgetfulIntrospectiveFriendlyArticulateAcceptedUnusualSincereHealthyConfidentTolerantCompromiserIntenseMild-manneredPatientHurriedStudiousMotivatedDisrespectfulAthleticArtisticOutgoingInwardIntolerantFlexibleFollows directionFunConscientiousSharesTalkativeAdventurous
Use this space to elaborate on any of the traits checked above or share any concerns. Keep in mind that we are looking for youth who complement each other when forming program delegations. There is no set profile of a "typical" or "ideal" youth delegate.
Do you know of any special talents or experiences that would help this youth applicant contribute to an international program?
To the best of your knowledge, does this youth applicant have any emotional or behavioral characteristics that would interfere withhis/her successful completion of a CISV program?
Behaviors that are never acceptable in any CISV program include illegal acts, alcohol/drug abuse, dishonesty, prejudice or intolerance, violence or lack of self-control, sexual contact, verbal abuse of others, and inability to handle a reasonable amount of stress. If you have seen the youth applicant exhibit such behaviors, please explain in the space below or call the Chapter contact person at the phone number listed on the front of this form.
The information provided above has been thoughtfully and honestly given, based on my knowledge and perception of the youth applicant. I understand that the information will be kept confidential and will be used by the local CISV Chapter in the evaluation of the youth applicant.
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CISV DFW Youth Delegate Reference Form

Reference Information