Thank you for taking the time to complete this reference. We would appreciate your honest and candid evaluation of this individual. If you are completing this request for multiple campers, please note that one reference must be submitted per camper.We expect our campers to treat each other with respect and honesty, as well as all they might come in contact with. Any information you provide will be held in strict confidence. It will only be reviewed by those officially involved in the scholarship selection process. If you have any questions or would like to speak to someone personally, please don't hesitate to call Brittany at 765-564-2898 x.291. We thank you for your assistance in helping us select scholarship candidates for our Summer Camp Program!
What is your name?
What is the name of the person for which you are completing this reference?
What is your relationship with this person?
What is your email address?
Number to best reach you?
Please describe the nature of your contact and the capacity in which you have known this person:
How extensive has your contact been with this person?
Please select one option per question when relating to the camper.
Please rate the camper candidate in the following areas.
Well Above Average
Well Below Average
Meets people easily. Makes a good impression. Friendly.
Readily accepted by others.
Displays characteristics such as humility, love, and empathy.
Able to work and play with many types of people.
Receptive to direction from others.
Supportive of adults and peers.
Accepts constructive criticism and authority well.
Self-confident and good emotional control.
Behavior standards are socially acceptable.
Would you personally be happy to recommend this individual for a scholarship to attend Camp Tecumseh YMCA?
Yes, no reservations
Yes, some reservation
If you listed no to the last question or would like to provide more detail as to why you answered a certain way in the chart above, please use the space provided below.
If there is anything else you would like us to know?
Signature-Please sign below
Should be Empty: