Camp Kirby CIT Reference Form 2019
The applicant who requested a reference from you has applied for the Camp Kirby CIT (Counselor-In-Training) Program. Camp Kirby is a resident camp for youth ages 6 to 18, and the CIT Program is a 3-week learning intensive leadership program. The applicant has given your name as one who can give us information regarding her/his qualifications, character and ability. References can be of help if they are honest and frank. If you have any doubts, please specify them and let us measure their importance as the applicant is interviewed. References will be kept confidential. Thank you!
Email address *
Who are you filling out a reference for? *
Your answer
What is your relationship with the applicant? *
Your answer
How long have you known the applicant? *
Your answer
Are you aware of any physical or emotional problems which may affect the applicant's performance? If yes, please explain. *
Your answer
Please explain why or why not you would have any reservations at all about entrusting the care of your children or belongings for an extended period of time with the applicant? *
Your answer
What is your overall appraisal of the applicant for the Counselor-In-Training program as a Counselor-In-Training for Camp Kirby? *
Your answer
PLEASE RATE THE APPLICANT ON THE FOLLOWING QUALITIES:
Cooperation with others *
Poor
Excellent
Dependability *
Poor
Excellent
Ability to arouse enthusiasm *
Poor
Excellent
Initiative *
Poor
Excellent
Sense of responsibility *
Poor
Excellent
Acceptance of supervision *
Poor
Excellent
Judgment *
Poor
Excellent
Emotional stability *
Poor
Excellent
Commands respect from adults *
Poor
Excellent
Commands respect from youth *
Poor
Excellent
Any additional information which would be pertinent to the applicant’s performance as a Counselor-In-Training at Camp Kirby?
Your answer
What is your name, phone number, and the best time to call or email? *
Your answer
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