FORM 2 – TEACHER/SCHOOL ADMINISTRATOR REFERRAL FORM

This signed form must be mailed with the candidate’s application.

PLEASE TYPE OR CLEARLY PRINT

Applicant’s First Name:
Applicant’s Last Name:
Name of High School:
Name of Teacher/School Administrator:
Title:
Department:
Telephone: 
E-mail:

The student whose name appears above is applying for a Marion Huber Learning Through Listening award, presented by Recording for the Blind & Dyslexic to members who are graduating high school seniors with learning disabilities, in recognition of extraordinary leadership, scholarship, enterprise and service to others. Your recommendation offering specific information about the accomplishments and qualifications of the applicant, and your comments as to how RFB&D has helped this student, will be most helpful to the selection committee in its evaluation.

Your estimation of the applicant’s performance, abilities and personal qualities will be carefully reviewed. If you are aware of contributions the applicant has made to the school or community, please comment on his/her talent, dedication and effectiveness.

This form must be attached to your letter of recommendation, which must be on school letterhead. Both documents must be mailed with the candidate’s application.

Signature: ______________________________________ Date: ____________________