Your Information

    Date of Reference

    Your Email (required)

    Reference Information

    First Name of Volunteer

    Last Name of Volunteer


    How long have you known this individual?

    Have you seen him/her interact with children, older adults, or vulnerable adults?


    If 'yes,' in what situation? Please describe the interactions.

    Please comment on any of the following areas in which you have personal knowledge:

    Candidate's problem solving skills

    His/her dependability/reliability (including punctuality)

    His/her patience

    Ability to get along with others

    On a scale of 1 (lowest) to 10 (highest) how would you rate his/her level of self confidence?

    Please briefly explain your answer

    Does this individual consistently exhibit:

    Respect for others, including respect for authority?

    A positive attitude?

    Do you have any concerns whatsoever about this person being in regular contact, supervised or unsupervised with children, vulnerable adults, or seniors?

    Do you have any other information that might relate to this individual including strengths, weaknesses, or ability to work appropriately with children which hasn’t been addressed yet in the above questions?