Reference Letter

Please fill out the following for the Student Applicant. We appreciate it!

Student Applicant Information:

* Indicates required field

Student Applicant First Name *

Student Applicant Last Name *

Student Applicant Date of Birth *

Referee Information (to be completed by a Referee who is well acquainted with the character traits of the Student Applicant)

Today's Date *

Referee First Name *

Job Title *

Referee Last Name *

Referee Phone Number *

Referee Email Address *

May we contact you about the Student Applicant? *

Yes No

What is the capacity that you know the Student Applicant and for how long? *

Student Applicant Character Traits:

What would you say is the Student Applicant's greatest character strength? *

What would you say is the Student Applicant's character strength requiring the most improvement? *

Please describe what you believe motivates the Student Applicant with an example of proof? *

A21 Academy Character Principles
Please complete 1-7 by choosing the most appropriate level for each criterion:

1. Respect & Compassion

2. Grit

3. Conscious Choice

4. Resilience

5. Character

6. Courteous Honesty

7. Altruistic

Altrutistic, compassionate towards others and actively seeks opportunity to serve community, global and universal issues. *

Confidentiality Agreement

The Applicant and/or all legal guardians/parents/referees shall hold and maintain confidential information in strictest confidence for the sole and exclusive benefit of A21 Academy Prep. The Student Applicant and/or all legal guardians/parents shall not, without prior written approval of A21 Academy Prep, publish, copy, or otherwise disclose to others, information pertaining to the application, registration, evaluations or offer sheet. Failure to uphold the policies and the non-disclosure agreement will necessitate immediate dismissal of the Student Applicant from A21 Academy Prep.

Thank you for your reference!
By Placing your initials in the box, you are signing this form. Please submit using the button and have a great day.

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