Reference Form for National Leadership Trainer Corps

Name of Trainer Applicant

Atlanta Area Brandywine Valley Chattanooga Cincinnati CISV International CISV USA Columbus Dallas Fort Worth Detroit Gulf Coast Jacksonville Maine Miami County Michigan City New York Northwest Ohio Philadelphia Pittsburgh Rocky Mountain San Francisco Smoky Mountain Springfield Washington DC Youngstown-Cleveland Chapter / Group Affiliation

Referee's name

Address

Phone

E-mail

The trainer applicant named above is applying to lead training workshops in the USA for Children's International Summer Villages, a peace education program. Please share with CISV USA's National Leadership Training Selection Committee the level of facilitation skills you have observed in the applicant and the occasions when those skills were observed.

Please rate the applicant in the following areas with five being the highest

Creativity Please select 1 2 3 4 5

Presentation Skills Please select 1 2 3 4 5

Flexibility Please select 1 2 3 4 5

Solicits input Please select 1 2 3 4 5

Subject matter knowledge Please select 1 2 3 4 5

Respect for others Please select 1 2 3 4 5

Thanks!