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National Leadership Trainer Referral Form

1. Referees name*
2. Referees phone number*
3. Referees address*
4. Referees email address*
5. Name of trainer applicant*
6. Applicant's Chapter Affiliation*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 Bay Area Smoky Mountain Springfield Washington DC Youngstown-Cleveland
7. Applicant's respect for others*Poor Fair Average Good Excellent
8. Applicant's facilitation skills*Poor Fair Average Good Excellent
9. Applicant's presentation skills*Poor Fair Average Good Excellent
10. Applicant solicits input*Poor Fair Average Good Excellent
11. Applicant's flexibility*Poor Fair Average Good Excellent
12. Applicant's creativity*Poor Fair Average Good Excellent
13. Applicant's subject matter knowledge*Poor Fair Average Good Excellent
14. Please add any additional information you feel the National Trainer Selection Committee needs to know about this applicant. If possible, speak to specific times when you have personally witnessed the applicant’s training abilities*

Thank you!

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