PLA Applications

PLA Referrer’s Recommendation Form

The referrer's recommendation form is the final step prospective PLA students must have completed to be considered for the President's Leadership Academy beginning in August, 2014. Each referrer for prospective PLA students must submit indiviudal recommendation forms.

1.Name and contact information for the first of the two referrers you are soliciting recommendations from. This individual must be a current or former teacher, guidance counselor, representative from a community based organization or religious institution.
Name of Nominee*
Name of Referrer*
Referrer's Phone Number (123-456-7890)*
Referrer's Email*
2.How long have you known the applicant?
3.In what capacity do you know the applicant?*
Teacher
Counselor
Community Organization
Religious Institution
4.The Selection Committee for the President's Leadership Academy would greatly appreciate your candid assessment of the applicant based upon your knowledge of their personal characteristics, commitment to personal development and interest in developing their leadership skills.

Openness to Feedback: the ability to seek advice and accept feedback from others*
5.Initiative: how the applicant approaches new situation; ability to set and accomplish goals; level of needed supervision*
6.Social Responsiveness: the ability to seek and develop an understanding of the needs of others and respond appropriately.*
7.Maturity: self-awareness and practice good judgement*
8.Responsibility: the degree to which the candidate is dependable and manages time effectively.*
9.Critical Thinking: the ability to understand and act upon complex concepts; a willingness to think outside of the box.*
10.Please provide additional comments that you believe would be helpful for the selection committee to make a decision.
11.Please indicate your final recommendation for the nominee.*
12.Please enter your full name and title.
Referrer's Name*
Referrer's Title*
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