Name of Student-Applicant Douglas College Student ID Name of Referee Phone number of Referee Email address of Referee Professional title of Referee teacher, coach, etc. Number of years working with student applicant Please rate and comment on your observations of the student-applicant in the following areas, using the rating scale described here: Rating scale: 5 = Excellent 4 3 = Average 2 1 = Poor In addition, in the fields provided, please explain which leadership task(s) you have observed the student-applicant involved in. If you have not observed them involved in the task specified, please leave the field blank. Student's overall leadership experience 5 4 3 2 1 Coaching experience if any Officiating experience if any Administration experience if any Leadership experience if any Volunteerism experience if any Other Please rate and comment on your observations of the student-applicant in the following areas, using the rating scale described here: Rating scale: 5 = Excellent 4 3 = Average 2 1 = Poor In addition, in the fields provided, please expand on the student's social charactaristics as described below. Social characteristics 5 4 3 2 1 i.e. confidence, interpersonal skills, cooperative and respectful Additional comments Please rate and comment on your observations of the student-applicant in the following areas, using the rating scale described here: Rating scale: 5 = Excellent 4 3 = Average 2 1 = Poor In addition, in the fields provided, please expand on the student's academic readiness as described below. Academic readiness 5 4 3 i.e. quality of homework, thoroughness, study skills, study habits Additional comments Final comments By checking this box I acknowledge that the information and opinions provided above are my own Leave this field blank