Master Instructor Reference Appraisal Form

Dear Master Instructor,

On separate paper please provide a written appraisal (typewritten please) of the candidate's strengths and weaknesses in the each of the areas listed below. For each trait or strength you may be requested to discuss 2 or 3 examples of each exhibited by the applicant, and to appraise the candidate's overall strength or weakness in that area. (Excellent= 4, Good = 3, Adequate = 2, and Poor =1)

(Circle one)

Leadership	4	3	2	1

Discuss two (2) specific leadership traits or strengths of the applicant.

Professional Ethics	4	3	2	1

Discuss two (2) specific examples of the applicant's level of professional ethics.

Training Presentation Experience	4	3	2	1

Give complete information depicting all of the applicant's experience related to giving training presentations at a local, state, and national conference or event during the last five (5) years.

Participation in Associations	4	3	2	1

Give complete information concerning all local, state, and national associations in which the applicant is currently a member.

Presentations at Associations	4	3	2	1

Give complete information concerning all presentations made by the applicant at state, local, national association meetings or conferences during the past five (5) years.

Program Development	4	3	2	1

Give complete information concerning all programs which the applicant has developed or strongly assisted in the development of during the past five (5) years.

Experience in Computer Use 4 3 2 1

Note:	This category is for information use only. It will not be used to determine an applicant's final score.

Please provide a description for the type of experience the applicant has in computer use.

Total Number of Points Scored: __________________

Applicant's Name	_

Master Instructor Name: ______________________________________

Master Instructor Signature _