Reference Form

* All reference forms must be e-mailed to

Beyond Bullies Online Teen Support Program

Reference Form

Name of Student: _________________________________

High School:

Your Name:




Please answer the following questions.

  1. How do you know this applicant?
  2. What are the applicant's gifts and skills?
  3. What is your opinion on the applicant's ability to follow through on commitments?
  4. How old is this student?
  5. What other information would help us evaluate this candidate's eligibility?