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.




Very Good




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