Newcomer Youth Engagement Project - Referral Form
Applicants:
Please show this link to your teacher or an adult who can tell us about you.
http://bit.ly/NYEPReferral
*If you do not have a teacher right now to make a referral you can have another adult
who is not a family member, complete this form.
For example, you might ask a sponsor, Imam, SSWIS, coworker or boss for help.
References:
Thank you for referring a student to the Newcomer Youth Engagement Program. You are a vital part to understanding if your student will be a good candidate for the program. You know this student, and we are grateful for any feedback you might provide to help determine the appropriateness of their placement in the program.
If you have any questions or additional comments to share please feel free to contact:
Tammi Bohle (Eastside school students)
tammi@saskatooniec.ca
office: 306.683.7779
Mike Stone (Westside school students)
mike@saskatooniec.ca
office: 306.683.7781
Wendy Hyshka (Program Coordinator)
wendy@saskatooniec.ca
office: 306.683.7783
* Required
Student Name (Last name, First name)
*
Your answer
Person making the referral (Last name, First name)
*
Your answer
Your phone number
*
Your answer
Your email
*
Your answer
Current CFR Levels (or CLB, below)
A1.1
A1.2
A2.1
A2.2
B1.1 or higher
Unknown
Reading
Writing
Listening
Speaking
A1.1
A1.2
A2.1
A2.2
B1.1 or higher
Unknown
Reading
Writing
Listening
Speaking
Current CLB Levels (or CFR, above)
CLB 1
CLB 2
CLB 3
CLB 4
CLB 5+
Unknown
Reading
Writing
Listening
Speaking
CLB 1
CLB 2
CLB 3
CLB 4
CLB 5+
Unknown
Reading
Writing
Listening
Speaking
Date of CFR/CLB Assessment (from above)
MM
/
DD
/
YYYY
Please list any credits this student has already completed with the Ministry of Education (eg. Commercial Cooking 10, Introduction to English A10)
Your answer
How do you know the applicant?
*
Your answer
How long have you known the applicant?
*
Your answer
School
*
Aden Bowman
Bedford Road
Bethlehem
BJM
Centennial
ED Feehan
Evan Hardy
Holy Cross
Marion Graham
Mount Royal
Nutana
St. Joseph
Tommy Douglas
Walter Murray
Other:
Please assign a value to each characteristic below:
*
1 (Weak)
2
3
4
5 (Strong)
Attitude
Attendance
Punctuality
Work habits (use of class time)
Ability to stay focused on a task
Works well with others
Work quality
Demonstrates respect
Demonstrates maturity
Demonstrates responsibility
Demonstrates initiative
1 (Weak)
2
3
4
5 (Strong)
Attitude
Attendance
Punctuality
Work habits (use of class time)
Ability to stay focused on a task
Works well with others
Work quality
Demonstrates respect
Demonstrates maturity
Demonstrates responsibility
Demonstrates initiative
Please describe why you believe this applicant needs the Newcomer Youth Engagement Program.
Your answer
Please describe the personal/learning strengths of this applicant.
Your answer
Please describe the personal/learning challenges of this applicant.
Your answer
What character traits, interests, skills, talents or abilities does this applicant have that would make them a good fit for this program?
Your answer
My recommendation for this applicant:
*
This student IS a good fit for this program.
This student IS NOT a good fit for this program.
Other:
Comments (add any other information you like here).
Your answer
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