Intern Reference Form
This person has applied for an intern position with Girl Scouts of Middle Tennessee and has selected you as a reference. The applicant has waived the right to see your response, and we appreciate your honest evaluation. Feel free to include a personal note of recommendation if you wish. Please indicate N/A for any questions you feel have not observed. Feel free to reach out to us at SummerCamp@gsmidtn.org if you have any questions. Thank you for your time and valued assistance.
Applicant Name
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First Name
Last Name
How long have you know the applicant?
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In what capacity?
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Please select the box that best reflects the applicant's leadership ability
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prefers to follow
makes some effort to lead
good ability to lead
exceptional ability to lead
How does the applicant respond to directions?
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Please share how this applicant functions in a group environment.
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What strengths and talents do you think the applicant will bring to a fast-paced camp environment?
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Camp requires attention to detail, stress management, and taking care of oneself. What can you share about the success the applicant would have in this type of environment and how would they cope?
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What difficulties do you think the applicant would be most likely to encounter if selected to be an intern, based on her unique challenges?
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Interns are in the unique position of being considered campers while also having responsibilities that help camp function. This means interns have a counselor whom they are responsible to and have limited access to technology, while also working alongside staff in various areas. Please describe how you think the applicant will handle this balance.
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No one applicant will excel in all areas listed below. Please candidly evaluate the applicant based on your observed knowledge using the following scale:
5-Excellent 4-Above Average 3-Average 2-Below Average 1-Lacking
Uses appropriate chain of command in solving problems
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Can be flexible and adjust to new and changing situations
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Reacts calmly and sensibly during times of stress
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Works cooperatively with others
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Expresses a sense of humor
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Fulfills responsibilities without requiring excessive amounts of reassurance and praise
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Demonstrates a sense of caring for and responsibility of others
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Practices effective listening and communications skills
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Is perceptive to situations going on in his/her surroundings
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Is highly motivated individual
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Demonstrates good judgment in decision making
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Serves as a positive role model for children by exemplifying high standards of integrity and personal character
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Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Would you consider this person for an internshipt?
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Yes
No
In what ways would the applicant grow and develop in an intern position?
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Any additional comments:
If needed, may we contact you for further information?
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Yes
No
Signature Authorization
Reference Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
To the best of my knowledge, all statements made or indicated on this Reference Form are true and represent my honest appraisal ofthe qualifications of the applicant.
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