2012-2013 COYAC Membership Application Recommendation Form

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Please distribute to two adults who can speak to different strengths you bring as a leader. We encourage you to use one teacher and one adult who knows you outside of school. _________________________________ is applying to become a member of the Colorado Youth Advisory Council (COYAC). S/he has contacted you to act as a reference in this application process. The duties of COYAC members include the ability to gather and represent the views of youth from his or her region, work well with a diverse set of fellow COYAC members to discuss important policy issues, and to share these views with the Colorado legislature. Please comment candidly on the applicant’s ability to carry out this role using the comment sheet below. We thank you for your time.
The Colorado Youth Advisory Council does not discriminate against any member or potential member on the basis of race, family income, gender, ethnicity, religion, sexual orientation, or disability. RECOMMENDER INFORMATION DATE RECEIVED_______________

Name of Reference: Relation to Applicant: Email: Phone Number: (______) - ______ - ________
Excellent Good Fair Poor

PLEASE CHECK THE APPROPRIATE BOX FOR EACH QUESTION BASED ON YOUR ASSESSMENT OF THE CANDIDATE.

Character Traits Intellectual promise Creative, original thought Ability to discuss ideas Disciplined work habits Maturity Motivation Leadership Ability Integrity Concern for others Self-confidence Initiative, independence Sense of responsibility Overall Rating

ADDITIONAL COMMENTS

Name of Applicant: Additional Comments:____________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
NOTE: If you would prefer to summarize your thoughts in a letter of recommendation for this student applicant, please feel free to do so.

Signature of Recommender: Date:
Please fax, email or mail this recommendation form and your letter to Ana Soler at The Civic Canopy 3532 Franklin St. Suite G Denver, CO 80205 Fax: 303-292-2061 Email: ana@civiccanopy.org It is essential that we receive all recommendations by our application deadline of May 31, 2013, for consideration for the 2013-2014 council. Please call Ana Soler with any questions at 303-292-3144.

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