FLIP 2017 Reference Form
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Instructions
This form is to be filled out by a teacher, counselor, mentor, or community leader on behalf of a prospective FLIP student. Reference forms for the Future Leaders in Planning program must be submitted by Friday, June 9, 2017 to meet the application deadline.
About FLIP
The Future Leaders in Planning (FLIP) summer program is a one-week leadership development opportunity offered free-of-charge to students who can contribute ideas to create a better future for the Chicago region. The FLIP program is currently seeking energetic and enthusiastic teens interested in voicing their concerns for the future of the region. Participants in FLIP will have the opportunity to learn more about our region and share their thoughts and ideas with other teens in the program (includes Cook, DuPage, Kane, Kendall, Lake, McHenry, and Will Counties). Students will also get to meet regional leaders who make key decisions on urban planning issues in our communities. Fore more information about FLIP, visit www.cmap.illinois.gov/about/involvement/flip.
Name of prospective FLIP student *
Please rate this student compared to his/her peers on the following: *
Poor
Average
Good
Superior
Academic performance
Overall character
On a scale of 1 (lowest) to 4 (highest) please rate the student on the following: *
1 (Low)
2
3
4 (High)
Self-discipline
Leadership
Ability to follow directions
Independence
Initiative
Reliability
Cooperation with others
Academic ability
Originality
Integrity
Analytical skills
Commitment to obligations
Please describe your relationship with the above candidate and briefly explain any exemplary actions he/she has taken to make a positive impact on the community (school community, local community, church community, etc.). Why do you believe the applicant should be chosen to participate in this program? *
Name of Recommender
Recommender's Phone Number
Recommender's E-mail Address
Relationship to FLIP Candidate *
Today's date *
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