Youth Applicant Reference Chapter Selection Chair Email: midwestohio-selectionchair@cisvusa.org Youth Delegate Reference Form Step 1 of 4 25% The following is a recommendation for a youth applicant for a CISV program.Delegate's Name(Required) First Last What program is the youth applying for?(Required) Village (Peace Education Camp for 11 year olds) Youth Meeting (Peace Education Camp for 12-13 year olds) Step Up (Peace Education Camp for 14-15 year olds) Fortnight (Peace Education Camp for 16-17 year olds) If selected, the youth applicant will represent the United States and their own area in an international setting. The local CISV USA Chapter requests your help in identifying applicants who exhibit leadership qualities and can represent their own culture successfully.*This form must be completed and received no later than January 15 of the program year.* Name of reference(Required) First Last Occupation(Required)Phone(Required)Email(Required) In what capacity do you know the youth applicant?(Required)If you are the youth applicant's current teacher, what is your school's name?(Required)School's PhoneOnly needed if you are the youth delegate's current teacherHow long have you known the youth delegate?(Required) Please select all attributes you believe the youth applicant displays(Required) Mature Independent Responsible Expresive Accepting Discerning Shows Inititive Optimistic Pesimistic Responsive Cooperation Cautious Curious Attentive Practical Helpful Participates Needs Coaxing Caring Spontaneous Reticent Open-Minded Respects Adults Respects Peers Follower Leader Team Player Fair-Minded Organized Dependent Creative Quiet Secure Vivacious Sensitive Forgetful Introspective Friendly Articulate Accepted Unusual Sincere Healthy Confident Tolerant Compromiser Intense Mild-Mannered Patient Hurried Studious Motivated Disrespectful Athletic Artistic Outgoing Inward Intolerant Flexible Follows Direction Fun Conscientious Shares Talkative Adventurous List the 5 adjectives from the ones you selected above that you feel describe the youth's greatest strengths.(Required)Use this area to elaborate on any of the attributes above or to share any concerns you might have.(Required)Keep in mind we are looking for youth who compliment 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 youth applicant contribute to an international program?To the best of your knowledge, does this youth applicant have any emotional or behavioral characteristics that would interfere with their successful completion of a CISV program? If yes, please explain.(Required)Behaviors that are never 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 you have seen the youth applicant exhibit such behaviors, please explain in the space below or email the Chapter contact person at midwestohio-selectionchair@cisvusa.org.(Required)Behaviors that are never 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 you have seen the youth applicant exhibit such behaviors, please explain in the space below or email the Chapter contact person at midwestohio-selectionchair@cisvusa.org.The information provided above has been thoughtfully and honestly given, based on my knowledge and perception of the youth 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.The information provided above has been thoughtfully and honestly given, based on my knowledge and perception of the youth 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. Signature(Required)
