Youth Leadership Broward Class XXIX

Youth Leadership Broward Class XXIX

Reference Form

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TO THE APPLICANT: Please write your name below and then give this reference form to an adult who knows you well, other than a parent or relative (i.e., teacher, administrator, mentor, minister, rabbi, employer, coach, etc.).

Student’s Name: ______

TO THE REFERENCE: Please submit the completed form via mail to Leadership Broward Foundation, Attn: Laura McRell, 1640 W. Oakland Park Blvd., Suite 400, Fort Lauderdale, FL 33311 or via e-mail to by April 2, 2015, and notify the student when you have sent this form.

Name: ______

Organization & Title: ______

Phone Number: ______E-mail address: ______

Relationship to student: ______

Length of time you have known student: ______

Please respond to the following questions to provide us insight on the above student. You may attach additional pages if necessary.

1) Please identify why you believe the student will benefit from participation in Youth Leadership Broward.

2) Please describe an instance where you have observed the student display leadership capabilities.

3) In what area(s) do you feel the student needs improvement?

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Reference Signature Date