Caswell Youth Council Reference

Thank you for making a difference in the lives of Caswell's Youth!

Please share with us why you believe this student would be a good fit for the Caswell Youth Council. You may refer as many students as you like. Please know that the information you provide about students MAY be shared with the student as part of individualized planning for each participant. Students must complete their application by January 17, 2025 to be considered. For more information, please contact Nicole Gibson at ngibson@caswellcountync.gov or 336.694.4129 ext 8125 or Shannon Moretz smoretz@compassionhealthcare.org or 336-694-9331 ext 221.

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* 1. Tell us who you are

Name *

Organization *

Role

Email Address *

Phone Number *

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* 2. Who are you referring?

Name

Email Address

Phone Number

Caswell Youth Council Reference

Thank you for making a difference in the lives of Caswell's Youth!

Question Title

* 1. Tell us who you are

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* 2. Who are you referring?

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* 3. How do you know this student?

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* 4. What knowledge, skills, traits, or other strengths do you believe this student will bring to the Caswell Youth Council?

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* 5. What would you like to see this student gain from participating in the Caswell Youth Council?