HLA Program Teacher/Adult Recommendation Form

**The Teacher Recommendation Form is only necessary for New HLAs**

Note to Applicant:

This should be filled out by the Adult/Teacher/Coach of your choice. This person must not be related to you. Your application is not complete without the Recommendation Form

Note to Teacher/Adult:

Please fill out this survey to the best of your ability. Form responses will not decide admission/acceptance into the Healthy Living Ambassador Program.

Check out the HLA website for more info

https://ucanr.edu/hla

https://ucanr.edu/hlaapply

✻ = Required

Your Name:

Your Position/School:

Name of Teen Applicant:

How do you know the Applicant:

How long have you known the Applicant:

Your email:

Phone number:

Please answer these questions to the best of your ability. The Rating scale is 1-5, 5 is Very Good

How would you rate the Applicants...

...ability to follow through on assignments? ✻

1 2 3 4 5

...attendance record? ✻

1 2 3 4 5

...accountability for their actions? ✻

1 2 3 4 5

...ability to think creatively/out-of-the-box? ✻

1 2 3 4 5

...follow-through? ✻

1 2 3 4 5

...leadership skills? ✻

1 2 3 4 5

...reliability? ✻

1 2 3 4 5

Anything else you would like to add about the applicant?