Personal Reference

Personal Reference

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Provided for (Volunteer Name):*

Email (Volunteer Email):*

Provided by (Your Name):*

Email (Your Email):*

Phone (Your Phone):*

1. How long have you known the applicant and in what capacity?*

2. Did you know the applicant was applying to be a mentor?*

If so, what was your reaction?

3. What is it like to have applicant as a friend?*

4. What personal strengths do you feel the applicant has to offer?*

5. Based on your knowledge of who the applicant has in his/her life, to whom would he/she be most likely to turn, or be most responsive to, for support or guidance?*

6. Can you tell me about the applicant’s community involvement and personal interests?

7. Can the applicant be counted on to follow through on the commitments he/she undertakes?*

Please Explain:

8. When have you witnessed the applicant interacting with children? How does the applicant interact with or relate to children?

9. Have you ever known the applicant to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?*

If so, please explain:

10. To your knowledge, has the applicant ever had any trouble following rules?*

If so, what kind of rules?

11. Is there anything that you are aware of that may interfere with the applicant’s ability to mentor or that would cause their commitment to our organization to come to an end?*

12. Has the applicant experienced an addiction, health or emotional concern that may impact his/her ability to participate actively in a match?*

13. Would anything need to change in the applicant’s home environment to be suitable for a child’s visit?*

If so, what?

14. Would you allow the applicant to develop a one-to-one relationship with your child or a child you care about?*

If not, why not?

15. Would you recommend the applicant as a mentor for a child or youth?*

16. Is there anything you would like to add that would aid us in our decision?

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I understand and agree to the above statements.

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