2026 CISV USA Austin Chapter Youth Delegate Reference Form

Youth Delegate Reference Form

CISV, Inc.

The youth applicant will be representing the United States and his/her own state and region in an international setting. The local Chapter of CISV requests your help in identifying an applicant who exhibits leadership qualities and can represent his/her own culture successfully in that setting

The following is a recommendation for the indivudual listed below:
Applicant (First and Last name)
This person is applying for:
Name of adult completing this reference form
Occupation of adult completing this reference form
Email address of adult completing this reference form
Capacity in which you know the youth applicant
If you are the child's current teacher, please include your:
School name
phone number
Length of time you have known the child
Please check all the traits you consider to be characteristic of this applicant.
Traits

MatureIndependentResponsibleExpressiveAcceptingDiscerningShows initiativeOptimisticPessimisticResponsiveCooperativeCautiouscuriousattentivepracticalhelpfulparticipatesneeds coaxingcaringspontaneousreticentopen-mindedrespects adultsrespects peersfollowerleaderteam playerfair-mindedorganizeddependentcreativequietsecurevivacioussensitiveforgetfulintrospectivefriendlyarticulateacceptedunusualsincerehealthyconfidenttolerantcompromiserintensemild-manneredpatienthurriedstudiousmotivateddisrespectfulathleticartisticoutgoinginwardintolerantflexiblefollows directionfunconscientioussharestalkativeadventurousOther
Check the FIVE adjectives in the list below that you feel describe the youth applicant's greatest strengths.

MatureIndependentResponsibleExpressiveAcceptingDiscerningShows initiativeOptimisticPessimisticResponsiveCooperativeCautiouscuriousattentivepracticalhelpfulparticipatesneeds coaxingcaringspontaneousreticentopen-mindedrespects adultsrespects peersfollowerleaderteam playerfair-mindedorganizeddependentcreativequietsecurevivacioussensitiveforgetfulintrospectivefriendlyarticulateacceptedunusualsincerehealthyconfidenttolerantcompromiserintensemild-manneredpatienthurriedstudiousmotivateddisrespectfulathleticartisticoutgoinginwardintolerantflexiblefollows directionfunconscientioussharestalkativeadventurousOther
Use this space to elaborate on any trait or any concern that would be helpful for the purposes of selecting this child for a CISV program. Keep in mind that we are looking for children 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 applicant contribute to an international program?
To the best of your knowledge, does this applicant have any emotional or behavioral characteristics that would interfere with his/her successful completion of a CISV program?
Behaviors that are NOT 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 "yes", 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 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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