Please Complete: VISIONS Reference Student Reference Response Student Reference Response Your Name Participant's Name If you do not see your name or the participant's name in the fields above, please contact us via phone or email.Thank you for your time and candor in answering the following questions about the applicant. Your reference is one of several pieces that help us determine an applicant’s suitability for a VISIONS program. Your comments and opinions will remain confidential. If you prefer to talk on the phone, please call us at 406-551-4423. How many years have you known the applicant?Please select... Less than 1 year 1-3 years 3 or more years Please rate the applicant using the following 1 to 5 scale. 1 = Area of High Concern; 3 = Average; 5 = Excellent. Kindness toward peers 1 2 3 4 5 Respectful of adults 1 2 3 4 5 Curiosity 1 2 3 4 5 Positive temperament 1 2 3 4 5 Work ethic 1 2 3 4 5 Ability to function positively outside of comfort zone 1 2 3 4 5 Ability to put group needs ahead of their own 1 2 3 4 5 Please use this space to provide any additional information about the above categories, particularly any you feel the applicant has significant room for improvement. Do you have any reservations about this applicant participating in a VISIONS program?Please select... Yes No Somewhat Please provide additional detail about your reservations. Do you feel that the applicant will positively contribute to the group dynamic?Please select... Yes No Somewhat Please provide additional detail about your response. Are you aware of any behavioral issues that could be a concern for the program?Please select... Yes No Somewhat Please provide additional detail about the behavioral issues. Please provide any additional comments to that you feel would be helpful. Thank you for your time! Contact Information Want to discuss your custom program? Contact Us
