Peer Educator Reference Form

ASC employs current students based on their academic achievement and expertise as Tutors and SI Leaders.

Student's Name Student's Name First Last
If known, what is the student's ID Number (100xxxxxxx number)
Your Name Your Name First Last
Title/Position/Organization
Office phone number Office phone number - ### - ### ####
Your UTA Email Address
How long have you known the applicant?
Academic
Has this student previously been enrolled in your course?

Has this student previously been enrolled in your course? Yes No
What course(s) if, has the applicant studied with you?
Does the applicant have an excellent command of the discipline matter?

Does the applicant have an excellent command of the discipline matter? Yes No
Will the applicant be able to communicate the discipline matter clearly and effectively?

Will the applicant be able to communicate the discipline matter clearly and effectively? Yes No
If the student was not enrolled in your course, have you worked closely with this student

If the student was not enrolled in your course, have you worked closely with this student Yes No N/A
Please rate this student's ability to think critically.
Please rate this student's commitment to education.
If the candidate does not meet the qualifications, are there other factors we should consider? (Please explain)
Personal
Please rate this student's interpersonal skills.
Please rate this student's reliability.
Please rate this student's use of constructive feedback.
Please rate this student's responsibility.
Please rate this student's ability to manage stress.
Please rate this student's ability to manage their time.
Please rate this student's ability to effectively solve problems.
Overall
Would you recommend this individual to tutor/SI the discipline matter he/she is applying for?
Please provide any concerns or additional comments you have regarding this applicant.

Peer Educator Reference Form

Academic

Personal

Overall