Multicultural Affairs Ambassador Faculty/Staff Reference Evaluation Form 2023-24

The purpose of this form is to assist the Office of Multicultural Affairs in evaluating applicants for our Student Ambassador Program. Your candid evaluation of the applicant, based upon your experience and knowledge, will play an important part in our selection process.

Application Deadline: Monday, March 6, 2023.

Contact Information
Reference's Name
Position
Email
Phone Phone - ### - ### ####
Evaluation
Applicant's Name
How well do you know the applicant?
Under what circumstances do you know the applicant?
We would appreciate your input on the applicant’s performance as an academic and social role model. To the best of your ability please assess the applicant's character and performance as it relates to each topic below.
1. Leadership: The ability to inspire others; to coordinate and lead activities; to facilitate group interaction.
2. Organization: The ability to prioritize tasks and manage time wisely.
3. Initiative: How this person approaches new situations: self-motivation; ability to set and accomplish goals and need for supervision.
4. Interpersonal Relationships: Attitude and ability to work with others; sincerity; flexibility; cooperation; the ability to work with a supervisor.
5. Responsibility: The degree to which the applicant is dependable, prompt, accurate, and complete.
6. Communication: The ability to grasp ideas; to read; speak and write effectively, to listen and convey understanding to others
7. Maturity: Common sense; self-awareness; judgment; integrity; ability to deal with a wide range of personalities.

Considering other college students you know, please rate this applicant according to the following criteria: 5 = Top 10% (best) 4 = Top 25% 3 = Top 50% 2 = Below 50% 1 = Don’t Know
	5	4	3	2	1
Leadership	Leadership5	Leadership4	Leadership3	Leadership2	Leadership1
Organization	Organization5	Organization4	Organization3	Organization2	Organization1
Tempermant	Tempermant5	Tempermant4	Tempermant3	Tempermant2	Tempermant1
Intiative	Intiative5	Intiative4	Intiative3	Intiative2	Intiative1
Interpersonal Relationships	Interpersonal Relationships5	Interpersonal Relationships4	Interpersonal Relationships3	Interpersonal Relationships2	Interpersonal Relationships1
Responsibility	Responsibility5	Responsibility4	Responsibility3	Responsibility2	Responsibility1
Communication	Communication5	Communication4	Communication3	Communication2	Communication1
Maturity	Maturity5	Maturity4	Maturity3	Maturity2	Maturity1
Emotional Stabilty	Emotional Stabilty5	Emotional Stabilty4	Emotional Stabilty3	Emotional Stabilty2	Emotional Stabilty1
Social Stability	Social Stability5	Social Stability4	Social Stability3	Social Stability2	Social Stability1

Additional comments on the applicant’s strengths and weaknesses and/or further explanation of things that might help the applicant:
Please indicate your reactions to this applicant’s potential for success by selecting one of the following responses:
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Multicultural Affairs Ambassador Faculty/Staff Reference Evaluation Form 2023-24

Multicultural Affairs Ambassador Faculty/Staff Reference Evaluation Form 2023-24

Contact Information

Evaluation