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The person named above has applied for a position as a counselor in our girls’ camp in Maine. Please accept our thanks in advance for giving your frank and confidential opinion of his/her suitability for this position.
Applicant’s Name :
(required)
How long have you know the applicant?
(required)
In what capacity?
Is this the type of person you would want as a counselor for
a child of your own?
select
Yes
No
Not Sure
What three words would you use to describe this person’s
strengths?
What three words would you use to describe this person’s
weaknessess?
Ability to Accept Supervision and constructive criticism
select
excellent
Good
Fair
Poor
No basis for judgment
Appearance
select
excellent
Good
Fair
Poor
No basis for judgment
Connecting with Children
select
Excellent
Good
Fair
Poor
No basis for judgment
Communication
select
Excellent
Good
Fair
Poor
No basis for judgment
Consideration for others
select
Unusually thoughtful
Usually Considerate
Rarely Considerate
Selfish
No basis for judgment
Energy
select
Excellent
Good
Fair
Poor
No basis for judgment
Enthusiasm
select
Excellent
Good
Fair
Poor
No basis for judgment
Friendliness
select
Excellent
Good
Fair
Poor
No basis for judgment
Dependability
select
Excellent
Good
Fair
Poor
No basis for judgment
Health
select
Excellent
Good
Fair
Poor
No basis for judgment
Humor
select
Delightful
Good
Inappropriate
Humorless
No basis for judgment
Integrity
select
Very Trustworthy
Usually Trustworthy
Occasionally Trustworthy
Untrustworthy
No basis for judgment
Leadership
select
Always takes initiative
Sometimes Leads
Follows
Never Leads
No basis for judgment
Loyalty
select
excellent
Good
Fair
Poor
No basis for judgment
Maturity
select
Very Mature
Appropriate
Somewhat Immature
Very Immature
No basis for judgment
Motivation
select
Very Ambitious
Eager
Average
No motivation
No basis for judgment
Responsibility
select
Always
Sometimes
Avoids
Never Accepts
No basis for judgment
Self-confidence
select
Healthy self image
Needs some support
Appears Overly Confident
Needs Much Reassurance
No basis for judgment
Social Attitude
select
excellent
Good
Fair
Poor
No basis for judgment
Teaching ability
select
excellent
Good
Fair
Poor
No basis for judgment
Tolerance
select
excellent
Good
Fair
Poor
No basis for judgment
Overall Rating
select
excellent
Good
Fair
Poor
Do you have any additional information that may be
helpful in our evaluation of this applicant?
Your Information
** Required
Your Full Name:
Your Email Address:
School or Business :
Address:
Daytime Phone Number:
Evening Phone Number:
Thank you for taking the time to complete this evaluation.
