Student Reference Form Apogee Adventures Student Reference Form Thank you for your willingness to serve as a reference for our program. The student you are referring has applied to participate in an Apogee Adventures program. Apogee offers co-ed, small-group outdoor-based experiences designed to contribute to a student's sense of community and personal accomplishment in a supportive environment. Please provide your answers to the questions below with the above in mind. We very much appreciate you taking the time to provide honest insight about this student. Student's Name*Your Name*What is your relationship to the student and how long have you known them?*(e.g. Are you a teacher, coach, mentor, other?)Is your work with the student primarily in a group setting or one on one?*Group SettingOne-on-oneIn a few words, how would you describe this student?*On a scale from 1 to 10 (1 being very reserved and 10 being very outgoing), is the student more reserved or outgoing?*1 (very reserved)2345678910 (very outgoing)Describe how this student does when interacting with a group of peers.*(e.g. do they usually dominate the group dynamic? Do they struggle if they aren't already friends with their groupmates?)Is there anything specific you feel the student needs in order to succeed in a small group environment?Many of our programs are designed to be physically challenging but within the reach of a motivated, moderately fit student. Are you aware of any reason the student might not succeed in such an environment?*NoYesIf yes, please elaborate here:Is the student consistently respectful of other students?*Yes, absolutelyMost of the timeNoIs the student consistently respectful of adults?*Yes, absolutelyMost of the timeNoIf you answered "most of the time" or "no" to either of the above questions about respectfulness, please briefly elaborate on how the student can be disrespectful of others:If you'd prefer to discuss this over the phone rather than type this out, just write: "please call to discuss" and we will follow-up with a phone call.Has the student ever presented any disciplinary concerns that you are aware of?*NoYesIf yes, please elaborate on the disciplinary concerns you have over this studentIf you'd prefer to discuss this over the phone rather than type this out, just write: "please call to discuss" and we will follow-up with a phone call.Is there any reason you would hesitate to recommend this student for the Apogee program to which they have applied?Any other comments?What is the best phone number to reach you at if we have follow-up questions about this student?*
