CIA Character Reference Form
Please provide an honest and detailed character reference for the applicant to Cooper International Academy. Your feedback will support our admissions process for a competitive preparatory academy.
Referee Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Position/Title
*
Institution/Organization
Relationship to Applicant
*
Please Select
Teacher
Counselor
Coach
Supervisor
Other
How long have you known the applicant?
*
In what capacity have you known the applicant?
*
Applicant Information
Applicant's Full Name
*
First Name
Last Name
Character and Academic Evaluation
Academic Ability
*
1
2
3
4
5
Leadership Skills
*
1
2
3
4
5
Integrity and Honesty
*
1
2
3
4
5
Initiative and Motivation
*
1
2
3
4
5
Respect for Others
*
1
2
3
4
5
Responsibility and Reliability
*
1
2
3
4
5
Emotional Maturity
*
1
2
3
4
5
Written Comments
What are the applicant’s greatest strengths?
*
In what areas can the applicant improve?
*
Describe a situation that demonstrates the applicant’s character or leadership.
Additional comments or information relevant to this application:
Overall Recommendation
I recommend this applicant:
*
With enthusiasm
Confidently
With some reservations
Do not recommend
Signature
*
Date
*
-
Month
-
Day
Year
Date
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