Tapawingo CIT Employer/Teacher Reference Form
This reference form is for Tapawingo CIT Applicants only. Reference form is to be completed by a teacher or recent employer.
Applicant's Name
First Name
Last Name
This person has applied for a place in the Counselor-in-Training Program at Camp Tapawingo. This person will be in a close community setting in the Adirondack State Park. This program will require flexibility and maturity. Please bear this in mind as you complete this reference. The applicant has agreed to release any person/company/agency from any liability for any damages whatsoever for information recorded on this reference form. The applicant waives her right to see this evaluation. Thank you for your candid assessment of the applicant. This reference will be used in conjunction with other referrals, a personal interview, and an application.
Your Name
First Name
Last Name
Phone Number
Email
Please choose one:
Employer
Teacher
How long have you known the applicant and in what capacity?
What are three words that best describe the applicant?
What are 3 areas in which the applicant has room to grow?
Would you feel confident in hiring/rehiring this person or having this person as a student another year?
Yes
No
Maybe
Please elaborate:
How does the applicant respond to stressful or challenging situations?
Stays calm and handles stress effectively
Sometimes struggles at first but usually adjusts with support
Frequently becomes overwhelmed in challenging situations
Has difficulty managing stress and needs significant guidance
Does the applicant demonstrate initiative and a willingness to serve others?
Consistently shows initiative and eagerly serves others
Often demonstrates initiative and willingness to help
Sometimes shows initiative but usually waits for direction
Rarely demonstrates initiative or willingness to serve others
How does the applicant respond to responsibilities and commitments?
Rarely responsible - Frequently neglects or forgets commitments; needs constant reminders.
Inconsistent – Sometimes follows through, but can be unreliable or need supervision.
Dependable – Usually follows through on responsibilities with minimal prompting.
Highly Responsible – Consistently reliable, often goes above expectations, and can be trusted fully.
Would you want your child or teenager placed under the direct charge, influence, or care of this individual?
Absolutely
Yes, with slight reservation
Probably not
No
Please select the following choices to the best of your knowledge:
Leadership Potential
Excellent
Average
Below Average
Poor
Cooperation
Excellent
Average
Below Average
Poor
Emotional Stability
Excellent
Average
Below Average
Poor
Intellect
Quick
Teachable
Average
Poor
Is the applicant in good physical condition (our program is rigorous--can she run 3 miles in 30 mins)?
Thank you very much for your assistance!
Submit
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