Los Angeles Diller Teen Fellows Reference Form 2014

Los Angeles Diller Teen Fellowship Reference Form 2014-15

Applications are Due ASAP

Please fill out the following form in oder to serve as a reference for an applicant seeking to participate in the Los Angeles Diller Teen Fellowship for the 2014-15 school year. This is a 15-month intensive identity, leadership, and community service program, where students learn and work together in a variety of settings, including overseas.

All applicants must be from the Greater Los Angeles area and in either the class of 2016 and 2017 (current freshman and sophomores).

More information is available about the program at the LA Diller Teen Fellowship Website, or by contacting Sami Stein Avner at Diller@westsidejcc.org or 323-556-5207.

Name of Applicant*

First Name

Last Name

Your Name*

First Name

Last Name

Agency & Title*

Your relationship to the applicant*

Your Phone*

Your Email*

Address

Address Line 1

Address Line 2

City

State

ZIP Code

The success of the program depends on the participants’ ability to: adjust to new environments and people; work and live cooperatively in an intensive group setting; maintain a sense of initiative and independence through positive energy and strength of character; creatively mobilize their peers to take action as future Jewish leaders.

While there is no single model of an exemplary Diller Teen Fellow, there are certain criteria that make a successful participant. Among those criteria are: emotional maturity and stability, openness to learning and new experiences, interpersonal skills, leadership potential, and creativity.

It is important that you describe the applicant as specifically and objectively as possible. Please share the candidate’s strengths and challenges. All information shall be kept confidential.

Thank you in advance for your help in identifying

young leaders within our community.

Please answer the following questions: