2024 Harvard Chan C-CHANGE Youth Summits: Scholarship Educator Reference
One of your students has applied for a scholarship to attend the Harvard Chan C-CHANGE Climate, Equity, and Health Summit and has indicated that you would be willing to provide a reference on their behalf. Each applicant is carefully selected based on the following guidelines. The scholarship provides full and partial need-based scholarships for underrepresented students to empower the next generation of climate and public health leaders and is designed for students who have a passion for climate change, equity and justice, and/or public health and show a demonstrated interest in climate and/or public health advocacy. To learn more about the Harvard Chan C-CHANGE Youth Summit on Climate, Equity, and Health, please visit: https://goputney.com/programs/harvard-chan-cchange-climate-program/.

Your reference is a valued and important part of our selection process and your honest response carries significant weight. If you feel uncomfortable recommending the applicant, please email the scholarship coordinator, scholarships@goputney.com, and we will contact the applicant to secure another reference.

All information you provide is confidential. References submitted are read only by the Harvard T.H Chan School of Public Health and the Putney Student Travel scholarship selection committees.
 
Please complete and submit this reference form as soon as possible. This form should be completed and submitted in one sitting as changes do not save if you navigate away from the page.

Please feel free to reach out with any questions, 802-387-5000 or scholarships@goputney.com
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Email *
Educator Name, Position, and Name of School: *
Your email address: *
Applicant Name (First and Last): *
Applicant Current Grade Level
Clear selection
How long have you know this student and in what capacity? *
Please indicate on a scale of 1-5 how highly you would rate this student in the following categories:

Curiosity 
 *
Indifferent
Highly Inquisitive
Participation in group settings *
Disengaged
Fully Engaged
Self-confidence *
Lacking Confidence
Fully Confident
Teamwork *
Uncooperative
Extremely cooperative/collaborative
Inclusive of differing ideas and identities/sensitivity to others
Often unaware or uncaring
Model of Inclusion
Clear selection
Accountability
Struggles with accountability
Takes responsibility for their actions
Clear selection
Ability to handle new experience and changing circumstances
Inflexible
Easily adaptable
Clear selection
Maturity
Immature for age
Model of maturity for age
Clear selection
If you marked any of the above questions 3 or below, please elaborate here.  *
How strongly would you recommend having this student on a program?
Clear selection
To your knowledge, has this student had any significant challenges that you feel are relevant to their participation in a program? If so, please explain. If none, please write "N/A" *
Is there anything else you would like to share about this student as we consider their candidacy for a program?  *
If you were leading or teaching at a program such as those described on the Harvard Chan C-CHANGE Youth Summits on Climate, Equity,  and Public Health website: https://goputney.com/programs/harvard-chan-cchange-climate-program/  would you be eager to have the applicant in your group? Why or why not? *
How would you rate the applicant on the following traits in comparison to other students in their peer group? Use a scale of 1 to 10, with 10 being the highest possible rate: Participation in group settings *
How would you rate the applicant on the following traits in comparison to other students in their peer group? Use a scale of 1 to 10, with 10 being the highest possible rate: Ease of handling adverse situations *
How would you rate the applicant on the following traits in comparison to other students in their peer group? Use a scale of 1 to 10, with 10 being the highest possible rate: Inclusion of people and alternate ideas *
How would you rate the applicant on the following traits in comparison to other students in their peer group? Use a scale of 1 to 10, with 10 being the highest possible rate: Self-direction *
How would you rate the applicant on the following traits in comparison to other students in their peer group? Use a scale of 1 to 10, with 10 being the highest possible rate: Communication *
How would you rate the applicant on the following traits in comparison to other students in their peer group? Use a scale of 1 to 10, with 10 being the highest possible rate: Confidence *
How would you rate the applicant on the following traits in comparison to other students in their peer group? Use a scale of 1 to 10, with 10 being the highest possible rate: Teamwork *
How would you rate the applicant on the following traits in comparison to other students in their peer group? Use a scale of 1 to 10, with 10 being the highest possible rate: Initiative *
Please pick one trait from the list above and briefly describe one example or situation in which the student excelled (or excels). *
Is there anything else you would like us to know? *
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