ACE PEER COUNSELOR REFERENCE FORM
TO THE ACE PEER COUNSELOR APPLICANT:
Please complete the information below and give this form to your reference. Select someone who is familiar with your
personal background, education, employment, and/or professional skills. You should not ask a family member, peer,
classmate, co-worker, or friend to serve as a reference. Consider asking CSF staff, work supervisors, clergy, teachers,
counselors, coaches, or someone else familiar with your motivation and community involvement.
Your reference should complete this form and return it to College Success Foundation following the instructions
at the end of this form.
Applicant’s Name:
LAST
FIRST
MIDDLE
Phone:
_________________________________________________________________________________________________
TO THE PERSONAL REFERENCE:
The College Success Foundation (CSF) has over 10 years of proven experience, inspiring underserved, low-income
students to finish high school, graduate college and succeed in life. Each summer, we hold a three-day Achievers College
Experience (ACE) for high school seniors to prepare them for college. Peer Counselors are responsible for providing
supervision, guidance, and support to students while residing on campus during the event.
The person named above is applying to be an ACE Peer Counselor. The applicant has indicated that you would be able to
evaluate his or her qualifications and provide us with a candid recommendation.
Reference Name:
LAST
FIRST
MIDDLE
Organization &
Title:
Physical Address:
STREET #/NAME
CITY
STATE
Email:
Phone:
KNOWLEDGE OF THE APPLICANT
How long have you known the applicant?
Months/Years:
In what capacity have you known the applicant? (Please check one.)
Job Supervisor/Employer
College Instructor
College Mentor Coordinator
CSF Staff Member
Volunteer Supervisor
Coach
High School Teacher
Other (specify)
Page 1 of 3
ZIP CODE
WORK PERFORMANCE
1. Please rate the applicant on such qualities as: level of dependability, initiative, and ability to work with minimal
supervision and as a member of a team.
Outstanding
Above average
Satisfactory
Below average
Unsatisfactory
2. In your judgment, how competent is this applicant, as demonstrated by work in the community, in school, on the job,
or in a position of responsibility? (Please check one.)
Outstanding performance
Above average performance
Satisfactory
Below average performance
Unsatisfactory performance
RELATIONSHIPS WITH OTHER PEOPLE
1. ACE Peer Counselors and Conference Assistants must work and communicate with people of varied cultural,
economic, educational, racial, and religious backgrounds. Please comment briefly on the applicant's relationships with
others and ability to work as a member of a team.
2. Please comment on the applicant's ability to adapt and work under difficult and changing conditions.
OVERALL RECOMMENDATION
What is your overall recommendation? (Please check one.)
I recommend the applicant for the position.
I have some reservations, but I believe the applicant will succeed.
I do not recommend this applicant.
Page 2 of 3
ADDITIONAL COMMENTS AND SUPPORTING INFORMATION (Optional)
If you wish, use additional paper to explain any of your ratings, and anything else about this applicant that you feel is
relevant to holding this position as the applicant's desire to serve others, maturity, work ethic, flexibility, and dependability.
_______________________________________________________________________________________
Thank you for taking the time to complete this reference.
Please E-mail, Mail or Fax this form to:
E-MAIL:
Please save the file with the applicant’s name
before emailing.
MAIL THIS FORM TO:
Reference@collegesuccessfoundation.org
College Success Foundation
FAX: 425-416-2001
ATTN: Human Resources
OR
Page 3 of 3
Attn: Human Resources
1605 NW Sammamish Road, Suite 200
Issaquah, WA 98027