Referral Form

THE UNIVERSITY OF ST LA SALLE BACOLOD THEO PLAN A PROGRAM EVALUATION FORM FOR APPLICANTS INSTRUCTION: (for the Applicants) 1. Fill up the Part A of this Recommendation Form 2. Give this Recommendation Form together with a long size white envelope to either of your RS1 or RS2 professor and ask him/her to evaluate you. *********************************************************************************** * Dear RS Faculty Your former student, _____________________________ of (course & section) __________ last (1st/2nd ) semester of AY ________ has applied to be a volunteer-catechist of the THEO PLAN A Program. In order for the moderator to assess this student’s qualification for the program, may I request your help in evaluating this student-applicant based on the following qualities which are necessary for the program. After you have filled up this form, kindly place this inside the envelope provided by the student and please seal the cover with your signature. Thank you so much for your assistance. The Theo Plan A Program Moderator. *********************************************************************************** * PART A: Student Applicant Data: (To be filled up by the student applicants) Name: ___________________________________

Yr. & Sec. __________________________

Name of RS1 Professor _____________________

Class Schedule ______________________

Name of RS2 Professor _____________________

Class Schedule ______________________

PART B: Student Evaluation and Recommendation (To be filled up by the RS Professor) please put a check mark on the appropriate box. EXCELLENT

OUTSTANDING

AVERAGE

NEEDS IMPROVEMENT

VERY POOR

1

Honesty & Trustworthiness Has the student been honest and can he/she be trusted to perform a task without close monitoring?

2

Christian Witnessing Has the student been able to show a strong level of Christian witnessing through a faithful observance of Christian Values & habits?

3

Communication Skills Has the student showed the ability to communicate clearly his/her ideas and beliefs?

4

Attendance How was the attendance rate of this student in your class?

5

Classroom Participation Has the student been actively involved in the learning process which took place in your class?

RS1 Final Grade ________________

or

RS2 Final Grade ____________

Based on my knowledge about the qualities of the person of this student, I hereby: recommend ( ) / do not recommend ( ) this student to be a volunteer catechist of the THEO PLAN A Program Name of Evaluator: __________________________

Signature _________________________