Global Outreach
4815 Whitetail Way Appleton, WI 54914
Executive Director: Barbara Tota-Boryczka
Phone: 920-540-3085
Spiritual Director: Fr. Larry Seidl
STUDENT APPLICATION 2018-2019
Student Application p.1
Teacher’s Recommendation
Global Outreach appreciates your confidential comments regarding this student who wishes to spend an academic year studying in the United States at a Catholic high school and living with a host family. Your evaluation of this student is very important in assisting us in our selection of mature students who will be excellent representatives of their home country and their school.
Student’s Name: Click or tap here to enter text. (Family name, First name,Middle name)
Name of person completing this form: Click or tap here to enter text.
Name of school: Click or tap here to enter text.
City: Click or tap here to enter text. Country: Click or tap here to enter text.
Please evaluate this student in the following areas: / Superior / Very Good / Good / Fair / Poor / CommentsVerbal English skills / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Written English skills / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Academic ability / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Academic performance / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Attitude toward school and schoolwork / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Ability to act with responsibility / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Initiative / motivation / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Self-confidence / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Humility / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Thoughtfulness / consideration of others / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Emotional stability / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Maturity / self-awareness / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Adaptability / flexibility / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Leadership skills / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Cooperative nature / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Friendliness / sociability / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Cooperation with authority / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Relationship with peers / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
General health / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Church involvement / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
Faith witness / ☐ / ☐ / ☐ / ☐ / ☐ / Click or tap here to enter text. /
- For how long have you known this student, and in what capacity? Click or tap here to enter text.
- What is your evaluation of this student’s potential success as an exchange student? Click or tap here to enter text.
- In your opinion, how will this student adjust to academic and social life in a U.S. Catholic school? What will be difficult? What will be easy? Click or tap here to enter text.
- How much would you recommend this student for an exchange with the Global Outreach program?
Student Application p.1
☐ I highly recommend with no reservations
☐ I recommend
☐ I generally recommend, with some reservations
☐ I do not recommend
Student Application p.1
Please make further comments below that will aid us in our selection of students. Thank you!
Click or tap here to enter text.
Thank you for your help.
Please print, sign, scan, and email to the above addresses.
Teacher’s Signature: ______
Date: Click or tap to enter a date.
Student Application p.1