College Leadership Forum

Recommendation Form

                                   

 

           

Applicant’s Name:    ___________________________________________________________

 

This student has asked you to provide an assessment of his/her suitability as a participant in the College Leadership Forum for students with disabilities.  Please provide information about the applicant’s leadership potential and interpersonal and academic skills.  Please compare the applicant to the peers on your campus.  If additional space is needed for comments, please feel free to attach a separate sheet of paper.  Please return the form to the office address provided on the second page, NOT to the student.  Thank you for taking the time to provide this important evaluation.

 

Characteristics

Outstanding

Very Good

Good

Fair

Poor

Unable to Judge

MOTIVATION:  Genuineness and depth of commitment to professional development

 

 

 

 

 

 

MATURITY:  Personal development, ability to cope with life situations

 

 

 

 

 

 

RELIABILITY:  Dependability, sense of responsibility, promptness, conscientiousness

 

 

 

 

 

 

INDEPENDENCE:  Ability to complete assigned tasks and to manage time and resources effectively

 

 

 

 

 

 

INTERPERSONAL RELATIONS:  Ability to get along with others, rapport, cooperation, attitude toward authority

 

 

 

 

 

 

PARTICIPATION:  Ability to actively participate in class/group discussions, and work with peers

 

 

 

 

 

 

EMPATHY:  Sensitivity to the needs of others

 

 

 

 

 

 

RESOURCEFULNESS:  Ability to discover and use new resources and to manage new and existing resources

 

 

 

 

 

 

INTEGRITY:  Honesty, trustworthiness, decency

 

 

 

 

 

 

INTELLECTUAL CAPACITY:  Ability to integrate learned material and work with a large quantity of information

 

 

 

 

 

 

COMMUNICATION SKILLS:  Verbal and non verbal skills, clarity of expression, fluency

 

 

 

 

 

 

 

Applicant’s Name

                                                                       

 

Applicant’s strengths as you see them:

 

 

 

 

 

 

Applicant’s weaknesses or leadership developmental needs as you see them:

 

 

 

 

 

 

Summary Evaluations:

 

 

 

 

 

 

 

Overall Recommendation:  (circle)           Excellent            Good            Fair            Poor

 

 

 

  ­­­­__________________________      _______________________  __________________

Evaluator’s Name                                   Signature                                     Date

 

­­­­­­­­­­_________________                ___________________           ________________________

Department                                  Position                                        E-mail address

 

 

__________________________________________              _______________________

Mailing Address                                                                                City, State, Zip code

 

(_____)_________________              ____________________________________________

Phone Number                                        Relationship to Applicant          

 

Deadline for postmark on Recommendation Form:  March 5th, 2006

 

Please send completed form directly to:

 

Iowa Division of Persons with Disabilities

Attn: CLF Committee

Lucas State Office Building

Des Moines, Iowa  50319
888-219-0471(V/TTY)