Intern Professional Reference Form – Tier 1 Tier 2

Carolina Cyber Network Professional Reference Form

Purpose:
The Carolina Cyber Network (CCN) requests that professional references complete this form to assist in evaluating applicants for cybersecurity internship opportunities. This reference should be provided by a supervisor, manager, coach, pastor, mentor, or community leader who can speak to the applicant’s professionalism, reliability, and character in a work or volunteer setting.

Applicant's name

Applicant's email

Applicant's school or has recently graduated from

Applicant Information:

Relationship to applicant *

Supervisor

Team Lead

Mentor

Pastor

OtherOther

How long have you known the applicant? *

Section 1: Ratings (0–5 Scale)

Please rate the applicant in the following areas, using 0 = Not Observed and 5 = Excellent.

Reliability and dependability: *

Professionalism and attitude: *

Work ethic and initiative: *

Adaptability and willingness to learn: *

Communication and teamwork: *

Integrity and respect for others: *

Section 2: Professional Reference Statement

Please provide your professional assessment of the applicant’s character and dependability. Include examples of work ethic, communication skills, teamwork, or initiative that you have personally observed. If applicable, describe situations where the applicant demonstrated leadership, responsibility, or a willingness to learn new skills. *

0 of 3000 max characters

Section 3: Overall Impression and Recommendation

Please share your overall impression of this applicant and their potential for success in a professional cybersecurity environment. *

0 of 3000 max characters

Would you work with or hire them again? *

Yes, without reservation

Yes, with some reservations

Please explain your selection: *

Certification: I affirm the above is accurate to the best of my knowledge.

Your Name *

Your Name

First Name

Last Name

Your Title/Role *

Your Organization *

Your Work Email *

Your Work Phone Number

Signature *

Clear

Date *

A copy of your responses will be emailed to the address you provided.