An applicant for Leadership Broward Class XLIII has selected you as a reference. The Selection Committee is interested in your statements regarding the applicant. The committee is aware of the time necessary to prepare this assessment and gratefully acknowledges your help in providing an honest appraisal of this applicant.

Applicant Name*

First Last

Reference Name*

First Last

Reference's Organization

Reference's Title

Address*

Street Address City State ZIP Code

Phone*

Email*

Are you an alumni of a Leadership Broward Program?*

If Yes – What is your Class Number?

Recommendation – Please Check One:

I recommend this applicant unreservedly.
I recommend this applicant with reservations.
This applicant is not an appropriate candidate.

TO THE REFERENCE:

Please answer the following questions. As you answer these questions, please consider the applicant’s skills and aptitude as they relate to professional motivation, leadership qualities, empathy for others and personal initiative.

How long, and in what capacity, have you known this applicant?*

What do you consider the applicant’s prime strengths to be?*

Why do you feel the Applicant is a good candidate for Leadership Broward Class XLIII?*

Please describe an instance where you observed the Applicant display his/her leadership capabilities. What was the outcome of the instance described?*

Please share any information you believe should be taken into consideration when reviewing this applicant.*

Please Print Your Full Name:

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