Person completing referral, your Name (First and Last) *
Your answer
Relationship to student *
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Indicate your level of recommendation for this student (Check one): *
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Leadership Checklist (Please mark all that apply to the student that you are referring for G&T Leadership) *
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Please describe the leadership strengths that this child has demonstrated compared to peers: *
Your answer
Describe opportunities provided in the student organization or other environment to challenge, motivate, or further develop these leadership strengths: *
Your answer
What one thing makes you feel strongly about the leadership qualities of this child? *
Your answer
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