Women In Community Action (WICA)

Debutante Program

P.O. Box 2292

Woodbridge, Virginia  22193

 

RECOMMENDATION FORM (Form must be received by October 4, 2024)

Debutante Program Recommendation Form 2025

Debutante Applicant Name(Required)
Character/ Integrity(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Responsibility(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Interaction with peers(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Interaction with adults(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Concern for others(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Team Player(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Initiative and drive(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Academic Motivation(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Contribution to School(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Contribution to Community(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Leadership demonstrated(Required)
Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)
Name(Required)
Business Address
This field is for validation purposes and should be left unchanged.

Thank you for your time and effort. Be assured that the information you supply will be kept in the strictest confidence. For any questions or concerns, you may call 571-345-5515. Please send the completed form via email to womenincommunityaction1976@gmail.com or in a sealed envelope, sign the flap, and return the envelope to the applicant or mail it to the address below by October 4, 2024.

WICA Debutante Program

17015 Batestown Road

Dumfries, VA  22025