MINNESOTA 4-H SHOOTING SPORTS & WILDLIFE PROGRAM
YOUTH AMBASSADOR REFERENCE FORM
Applicant’s Name:
Name of Individual Giving Reference: First Name:
Title:
Last Name:
Telephone: (_____)
How long have you known the applicant?
The above named person is applying for a volunteer position with the Minnesota 4-H Statewide
Shooting Sports and Wildlife Program. Youth will attend a two-day training in which they will learn
aspects of the Minnesota 4-H Shooting Sports and Wildlife Program, develop personal vision
statements, and learn skills in public presentation, etiquette, and partnerships development.
Expectations of the ambassador will include:
 Enrolled as a Minnesota 4-H Member
 Be a positive role model at the club and county program levels
 Be knowledgeable in the Shooting Sports and Wildlife Areas
 Be actively engaged in the program and attend events throughout the year
It is of great importance to us to obtain as much information as possible about the applicant’s abilities and
character in order to select the most qualified ambassadors to represent our youth program. Any
information you provide will be regarded as strictly confidential.
Thank you for your time and thoroughness in answering the following questions:
Describe the applicant’s personality.
Describe the applicant’s strengths.
© 2011 Regents of the University of Minnesota. All rights reserved. University of Minnesota Extension is an equal opportunity educator and employer. In
accordance with the Americans with Disabilities Act, this material is available in alternative formats upon request. Direct requests to 507-529-2791.
Please rate the applicant on a scale of 1-10 in the following areas, with 10 being the highest score.
Needs significant
Average
Excellent
Improvement
Flexibility
1
2
3
4
5
6
7
8
9
10
Dependability
1
2
3
4
5
6
7
8
9
10
Maturity
1
2
3
4
5
6
7
8
9
10
Judgment
1
2
3
4
5
6
7
8
9
10
Communication Skills 1
2
3
4
5
6
7
8
9
10
Working with Others 1
2
3
4
5
6
7
8
9
10
Ability to Accept
1
2
3
4
5
6
7
8
9
10
Feedback
Patience
1
2
3
4
5
6
7
8
9
10
Ability to handle
Stress
1
2
3
4
5
6
7
8
9
10
Caring for Others
1
2
3
4
5
6
7
8
9
10
Please check the characteristics below that best describe the applicant: (Check all that apply)
Always takes the lead
Balanced and controlled
Over-responds emotionally
Well liked
Avoided by others
LEADERSHIP
Comfortable in leadership roles
EMOTIONAL TEMPERAMENT
Unpredictable
Tends to be moody
SOCIAL INTERACTION
Sought out by Others
Usually just blends in
Prefers to follow
Always cheerful
Other: _______________
Tolerated by Others
Additional Comments:
Signature ___________________________________________________________ Date_________________
Thank you for helping us find the best possible representatives of our youth program!
Please return form to: Extension Regional Office, Rochester,
Attn: Nicole Pokorney, 863 30th Avenue SE, Rochester, MN 55904
Return form: Fax: 507-536-6311 or e-mail: pokorney@umn.edu
© 2011 Regents of the University of Minnesota. All rights reserved. University of Minnesota Extension is an equal opportunity educator and employer. In
accordance with the Americans with Disabilities Act, this material is available in alternative formats upon request. Direct requests to 507-529-2791.