Reference Form

The person who has sent you this form has applied to work in an American summer camp for the upcoming summer. Applicants will be
put in direct contact with children of all ages, which could cause considerable stress.

Positions at camp will run for an average of eight weeks and the applicant will most likely be living in a cabin with his/her campers if
employed as a counselor, or coming into regular contact with children daily, if employed as support staff

Part of the extensive application process requires submitting at least one reference from someone who has known the applicant in a
professional degree and is not a family member or a friend. The person providing this reference must have a good knowledge of the
applicant’s character and be able to make an objective assessment.

Camp directors endeavor to enrich the environment of their camps and a great way of doing this is to bring in staff members of
different backgrounds and from different countries to work with the children.

The summer camp environment can be a very fast paced and fluid environment. Applicants must be open minded, adaptable, and hard
working. Applicants could be asked to do a variety of tasks from simply supervising their campers during a meal to more advanced
instruction of high risk activities.

We are looking for applicants that hold a calm and mature temperament, are positive role models, recognize boundaries, respond well
to authority, respect camp rules, respect others, can organize themselves, and appreciate the trust placed upon them.

Your honest assessment is appreciated. If you have any reservations and wish to share with IENA in confidence, please contact
camp@iena.org

NOTE: We only accept references that are from a professor, employer, former employer or teacher. If you are a co-worker,
family friend, colleague etc. please do not complete the reference as it will be disregarded. Thank you.

APPLICANT
Applicants Name:

REFERENCE
Your Name: Title:

E Mail Address: Telephone Number:

Company/Institution?

What is your connection to the applicant: Current or Past Supervisor Professor/Teacher Current or Past Employer

If you have employed the applicant, in what capacity? Dates of Employment:

How long have you known the applicant? Your most recent contact?

APPLICANT INFORMATION
How well does the applicant relate to children and other people?

What particular experience, skills, and personal qualities does the applicant possess that makes him/her suitable for this program?
Would you employ the applicant to teach these skills and work with children?

Are you aware of any health or other issues which might make the applicant unsuitable for working at camp?

Would you recommend the applicant for participation in a cultural exchange program?

RATE the FOLLOWING (check the appropriate box)

Excellent Good Fair Poor
Attituded
Adaptability
Responsibility
Tolerance
Enthusiasm
Leadership
Initiative
Patience
Sense of Humor
Loyalty
Maturity
Organization
Warmth
Cooperation
OVERALL RECOMMENDATION (check one)

Excellent Good Fair Poor

REFERENCE SIGNATURE
Signature:
Date:
NOTE: REFERENCE NOT ACCEPTED UNLESS SIGNED
Address:

IENA
699 Washington Street, STE 203
Hackettstown NJ 07840 USA
Phone/fax: 888 724 4292