2015 Recommendation Form

for Xavier Entrepreneurship Boot Camp

Applicant
Student’s Name / Click here to enter text.
Student’s High School / Click here to enter text.
Recommendation
Any adult who has supervised this student may fill out this form (e.g., teacher, coach, extracurricular activity leader, etc.). The adult cannot be related to the student or living in the same household with the student.
Recommender’s Name / Click here to enter text.
Recommender’s Employment
1.  How do you know this student? Please describe. / Click here to enter text.
2.  If a teacher, indicate the grade and subjects you taught this student. / Click here to enter text.
3.  How long have you known this student? (years/months) / Click here to enter text.
4.  Do you recommend this student? (check appropriate box) / . / Enthusiastically / . / I do not recommend this student
(go directly to signature)
. / With some reservations
5.  Indicate your evaluation of this student’s personal qualities.
(Describes the student well = 5; Does NOT describe the student = 1).
Qualities / Ranking
The student is… / 1 / 2 / 3 / 4 / 5
able to see perspectives others don’t see / . / . / . / . / .
Inquisitive and curious / . / . / . / . / .
able to “dive deep” into topics and grasp underlying principles / . / . / . / . / .
often expressing creativity and originality of thought / . / . / . / . / .
coachable; accepts constructive criticism and applies it
self-disciplined, responsible & follows through on projects / . / . / . / . / .
willing to take risks / . / . / . / . / .
self-motivated; shows initiative and drive / . / . / . / . / .
flexible; adapts to new situations & accepts change / . / . / . / . / .
socially and emotionally mature / . / . / . / . / .
ethical and has high integrity / . / . / . / . / .
able to work collaboratively with others and be a contributing member of a team / . / . / . / . / .
6.  What is most unique about this student? If you are aware of any hardships/conditions (social, emotional, otherwise) that may affect this student’s participation in XU Entrep. Boot Camp, please note them here.
7.  Based on your experience with the student, how do you think Entrep. Boot Camp will impact this student?
8. Please provide any other information you would like us to know about this student.
Signature
Mark boxes to confirm. / . / ·  I certify that I am not related to this student and do not live in the same household as this student.
. / ·  I do not mind being contacted by Xavier Entrep. Boot Camp.
Signature:
(must be written) / Date: Click here to enter text.
Email:
(required) / Click here to enter text. / Phone:
(Required) Click here to enter text.
Where to Send
Please email your completed and signed form to
Recommendations must be received BY THE APPLICATION DEADLINE of April 20, 2015
Form available at: http://www.xavier.edu/summer/high-school-programs/Entrepreneurship-BootCamp.cfm