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Applicant Recommendation Form

Please have the person recommending the applicant fill out the form below.

"*" indicates required fields

Applicant Name*

First Last

Person Completing Form*

First Last

Relationship to Applicant*

Years Known Applicant*

Date*

MM slash DD slash YYYY

Please rate the applicant in the following areas using the following scale (1 = Low, 5 = High)

Initiative*

1

2

3

4

5

Motivation*

1

2

3

4

5

Reliability*

1

2

3

4

5

Self-Advocacy*

1

2

3

4

5

General Attitude*

1

2

3

4

5

Self-Sufficiency*

1

2

3

4

5

Ability to relate to peers*

1

2

3

4

5

Ability to relate to teachers/staff*

1

2

3

4

5

Ability to attend to daily schedule*

1

2

3

4

5

Ability to make decisions*

1

2

3

4

5

Ability to react in an emergency/follow health, safety rules*

1

2

3

4

5

Ability to use people as resources*

1

2

3

4

5

Emotional stability*

1

2

3

4

5

Ability to cope with stress*

1

2

3

4

5

Ability to adjust to new situations*

1

2

3

4

5

Ability to separate own problems from those of others*

1

2

3

4

5

What would you consider the applicant’s strengths?*

General comments and concerns*

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Now Accepting Applications Spring 2022

Contact Weston Bridges to learn more about our independent community living.

info@foxvalleydevelopers.com

630-892-5762

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