Lyon College Resident Assistant Reference Form Please return reference form by January 21, 2014

Part 1 (to be completed by Applicant) Please give this form to three references. Your reference will return the form to Kim Hinds-Brush in Student Life at Lyon College. The references may be from a residence life staff member (RA or Resident Faculty Mentor), college staff member, faculty member, or anyone you feel can be a reference for you with this position but one must be from a current RA.

Applicant: The Family Educational and Privacy Act of 1974 opened student records for inspection. The law also permits students to sign a waiver relinquishing their rights to see letters of recommendation. Please complete the statement below.

I ______waive ______do not waive my right to have access to this Personal Reference Form.

______Applicant Name (Print)

______Date______Signature of Applicant

Part 2 Reference (to be completed by reference)

How long have you known the candidate: ______

Under what circumstances do you know the candidate: ______

Considering other college students you know, please rate this candidate according to the following criteria.

5 – Excellent 4- Above Average 3- Average 2- Has Potential 1- Needs Improvement UN - Unknown

Leadership 5 4 3 2 1 UN Ability to inspire others Ability to coordinate and lead activities Ability to facilitate a group Organization 5 4 3 2 1 UN Ability to prioritize tasks Ability to manage time wisely Temperament 5 4 3 2 1 UN Ability to maintain a positive outlook Realistic perspective Initiative 5 4 3 2 1 UN How this person approaches new situations Self motivation Ability to set and accomplish goals Ability to work unsupervised Interpersonal Relationships 5 4 3 2 1 UN Appreciation of diversity Attitude and ability to work with others Sincerity Flexibility Cooperation Ability to work with a supervisor Responsibility 5 4 3 2 1 UN Dependable Prompt Communication 5 4 3 2 1 UN Ability to grasp ideas Ability to listen and convey understanding to others Maturity 5 4 3 2 1 UN Ability to deal with a wide range of personalities Common sense, judgment Emotional Stability 5 4 3 2 1 UN Direction and control of emotional response Social sensitivity 5 4 3 2 1 UN Ability to be sensitive to and understand the feelings and reactions of others Ability to effectively respond to difficult situations

Additional Comments

Signature of reference Date

Print name of reference Phone number or email address

Please return this reference to: Lyon College, Department of Residence Life Kim Hinds-Brush 2300 Highland Rd. Batesville, AR 72501 Phone 870-307-7375 Email [email protected]