Regional Recommendation Form

Applicant's Name*
First Last
Applicant's Email*
PROGRAM APPLICANT APPLYING FOR:*
Name of NCSY/JSU staff member recommending this teen:*
First Last
Email:*
Phone:*
Your position in NCSY:*
How long have you known this teen and in what primary context?*
Please check off all the events this teen participates in (that you know of):*
- JSU Clubs
- Latte N'Learn
- Friday Night Onegs
- Regional Shabbatons
- City Shabbatons
- Summer Programs
- Monthly Events
- Yom Tov/Chol Hamoed events
- Yarchei Kallah
- Volunteer events
- Chapter Board
- Regional Board
- National Board
- Other
If you checked other, please describe:*
Jewish Knowledge and Attitues
How would you rate this teen's attitude towards Judaism?*
- 1 - Positive and motivated to learn and do more.
- 2 - Curious about Jewish life and learning. Proud of his/her Judaism. Apprehensive about commitment.
- 3 - He/she doesn't have strong feelings about his/her Judaism.
- 4 - Has negative views about Judaism.
Please explain:*
How would you rate this teen's Jewish knowledge?*
- 1 - Highly knowledgable.
- 2 - Basic knowledge of Jewish concepts.
- 3 - Vague sense of basic Jewish knowledge. Family fulfills basic Jewish tradition.
- 4 - Little to no understanding of Judaism. Not actively engaged in the exploration of Jewish life and learning.
How would you rate this teen's Jewish practice?*
- 1 - Observant according to Orthodox standards.
- 2 - Culturally Orthodox but not fully observant.
- 3 - Cultural/Traditional Jewish Practice.
- 4 - Unaffiliated
What is his/her level of Shabbat observance? Please pick the one that is closest.*
- 1 - Completely Shomer Shabbat.
- 2 - Identifies as Shomer Shabbat but uses technology.
- 3 - Not Shomer Shabbat but might attend services or have a shabbat meal.
- 4 - Not Shomer Shabbat at all.
What is his/her level of kashrut?*
- 1 - Completely kosher.
- 2 - Kosher home but he/she eats non-kosher out.
- 3 - Does not keep kosher at all.
What is his/her highest level of formal Jewish education?*
- 1 - Jewish High School
- 2 - Jewish Elementary School
- 3 - Jewish Supplemental School ( Hebrew School/Torah High)
- 4 - No Formal Jewish Education
How would you rate this teen's family support of his/her Jewish growth?*
- 1 - Highly supportive
- 2 - Indifferent
- 3 - Unsupportive
- 4 - Adversarial
- I'm not sure
Motivation & Maturity
How would you rate this teen's social maturity?*
- 1 - Readily views program goals above personal comfort. Happy to help other participants without being asked. Not judgemental of others.
- 2 - Well liked and makes friends easily. Primarily focused on him/herself and/or close friends.
- 3 - Does not always react appropriately to the mood of the program or sensitivity of others. Has trouble making and/or retaining friends. With advisor assitance, can integrate into the group.
- 4 - Routinely misses social cues. Inability to consider needs or perspectives of others. Requires constant advisor help and supervision.
How would you rate this teen's emotional maturity?*
- 1 - Mature beyond his/her years. Has the ability to express and regulate his/her emotions.
- 2 - Responds to emotional situations appropriately for his/her age.
- 3 - Emotionally immature.
- 4 - Expresses emotions inappropriately.
- I don't know
How would you rate this teen's physical capabilities?*
- 1 - The NCSYer at the front of the hike.
- 2 - Capable of completing 6-7 hour hikes. Might need motivation.
- 3 - NCSYer at the back of the hike. Might not enjoy it, but will persevere.
- 4 - Will not be able to complete the hike in time with the group/physically unfit.
- I'm not sure.
How would you rate this teen's motivation?*
- 1 - Actively participates in all programs and engaged in discussions.
- 2 - Attends programming willingly. Engages sporadically. Does not distract or disrupt regardless of who is running the program.
- 3 - Easily influenced by the environment, both for positive and negative outcomes (Example: Peers/Relationship with staff running program)
- 4 - Actively disruptive and avoids attending programming.
Behavioral Concerns
To your knowledge, has the applicant been involved in any incident involving drugs, alcohol, smoking or inappropriate behavior?*
- Yes
- No
If yes, please explain:*
To your knowledge, has the applicant been expelled from any school, camp or any other program?*
- Yes
- No
If yes, please explain:*
Do you recommend that this teen should go on the program they are applying for?*
- Yes
- No
If no, please explain why this teen is unsuitable for this program: (if applicable suggest the NCSY program that is appropriate for this teen to attend)*
Is there any additional information you would like the Program/Bus Director to be aware of?

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