2016 Camp CEO Reference Form

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You have been asked to be a reference for a potential Camp CEO attendee.

About Camp CEO: Learning how to be a successful leader is not an easy task – it takes time and effort along with practice and patience. Camp CEO is an opportunity for a young woman to spend a weekend at camp with accomplished female women from New Mexico. These women will share their insights on how to be successful in today’s world while participating in traditional camp activities with you, including the low ropes course! Through this unique program these young women will discover more about themselves and their dreams while receiving encouragement and mentoring from today’s successful women. Each will come home from Camp CEO with the self-confidence and knowledge needed to begin the journey of making their dreams a reality.

Your prompt attention in completing this form is greatly appreciated. A PDF version of this application is also available on our website: www.NMGirlScouts.org

Please answer the questions following to the best of your ability.

Applicant Name *

Applicant Information

Applicant's phone number *

Reference Questions

How long have you known the applicant? *

What is your relationship to the applicant? *

Please rate the following on a scale of 1-3 *

5 = Excellent

4 = Above Average

3 = Average

2 = Below Average

1 = Not Observed / Unknown

Has poise & ease in meeting people

Is able to relate well to peers

Is able to relate well to adults

Is able to work well in a group

Accepts differences in people

Effectively communicates with others

Is dependable and responsible

Is self-motivated & takes initiative

Is flexible and adapts as needed

Is mature for her age

Please write a short statement related to the leadership traits you currently observe in this applicant or the potential you believe this applicant possesses. *

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