PARTNERS OF THE AMERICAS              Confidential Reference
To the person completing this form on behalf of the student: The student is applying to travel to Costa Rica with the Partners of the Americas Student Exchange Program. The program offers a cultural and language immersion experience for high school students in Oregon. The student will live with 2 host families for 4 weeks each and attend high school with their host sibling. Thank you for taking the time to complete this form as a confidential reference for the student traveler.
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Your Name *
First and Last Name of reference completing this form.
Email Address *
Phone Number *
Place of Employment *
Please answer the following questions in regards to the student who is appying to travel.
First Name of Student *
Last Name of Student . *
Type of Reference
 *
For the following questions please rank the the applicant on the listed characteristics. Applicants do not need a 5 on every characteristic in order to travel.  Your opinions help with placement and group dynamics. 

Use the following scale:  

 0 = Don't Know         1 = Never               5 = Always 
Positive & Cheerful
 *
 0 = Don't Know         1 = Never               5 = Always 
Don't Know
Always
Adaptable & Flexible
 *
 0 = Don't Know         1 = Never               5 = Always 
Don't Know
Always
Courteous & Respectful
 *
 0 = Don't Know         1 = Never               5 = Always 
Don't Know
Always
Outgoing & Friendly
 *
 0 = Don't Know         1 = Never               5 = Always 
Don't Know
Always
Team Player & Collaborative
 *
 0 = Don't Know         1 = Never               5 = Always 
Don't Know
Always
Follows Directions & Cooperative
 *
 0 = Don't Know         1 = Never               5 = Always 
Don't Know
Always
Do you recommend this student to travel with the Partners of Americas Program as a representative of Oregon? *
Please add any additional that could help us determine if the student is a good candidate to be immersed in a new culture and language for 8 weeks in Costa Rica this summer.
Electronic Signature
 *
Type your name to confirm that you are providing accurate information as a reference for the student applicant.
Date
 *
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