Junior Leadership Macomb
Reference Form
This student is applying to participate in Junior Leadership Macomb, an eight day leadership experience for high
‘school students, Students will gain new information on the assets/issues of Macomb County through group discussions,
field trips and interactive exercises about issues facing the Macomb County and the region.
Please complete this form to the best of your knowledge and return by mail to:
Leadership Macomb 59 N Walnut, Ste 302 Mt. Clemens, MI 48043, fax to 586.792.2803 or scan and email
to Karen Smith: smith@leadershipmacomborg
Return by 6/30/2014 Thank you.
Referralfor “DALEY. Flpne
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Referral by:_ Secor Peoee Phone: SB0-BZ5 2400.
Email:_Sacre@weskids.net — SUS
What is your relationship with the applicant?
Counselor Employer: Coach —Pastor/Minister Other:
Are you a graduate of Leadership Macomb? (please circle) yes
How long and in what setting have you known the applicant?_ 2 425 — TAveir ATH
two Mims Coos at Navona. Maniowanes Gryene TEA
‘The student displays or possesses (check all that appl CENTER
Academic Achievement _Positive Attitude _~ Integrity or Character
Xself-Esteem _¥cood Study Habits _~ Goal Setting Skis
_Y Good Social Skills _¥ Compassion _Strong Work Ethic
_sZ Leadership Skills _& Ability to work well with others
Please comment on the student's leadership skills and potential:
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Please comment on the student's sense of responsibility:
BMLEG 1s ONE OF THE Most LESPONSIBLE STLDENTS
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Share any ad iments on the back of this sheet.
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