Significant Other/Partner 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 your partner?*

2. Did you know your partner was applying to be a mentor?*

If so, what was your reaction?

3. Are you supportive of your partner’s application to become a mentor with Big Brothers Big Sisters?*

4. What is it like to have applicant as your partner?*

5. How much free time does your partner have?*

6. What personal strengths do you feel your partner has to offer?*

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

8. Can you tell me about your partner’s community involvement and personal interests?

9. Can your partner be counted on to follow through on the commitments he/she undertakes?*

Please Explain:

10. When have you witnessed your partner interacting with children? How does s/he interact with or relate to children?

11. Have you ever known your partner to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?*

If so, please explain:

12. To your knowledge, has your partner ever had any trouble following rules?*

If so, what kind of rules?

13. Are you aware of any complaints being made or disciplinary actions being taken against your partner?*

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

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

16. Would anything need to change in your home environment to be suitable for a child’s visit?*

If so, what?

17. Would you recommend your partner as a mentor for a child or youth?*

18. 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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Significant Other/Partner Reference

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