Adult Site Based Reference Form
Applicant Information
Volunteer Applicant First Name
Volunteer Applicant Last Name
Volunteer Applicant Date of Birth
Reference Information
Reference First Name
Reference Last Name
Reference Phone Number
Reference Email
Block 1
1. How long have you known the volunteer?
2.In what capacity do you know the volunteer (your relationship to him/her)?
Please select...
Adult Child of Volunteer
Community Contact
Co-Worker
Employer
Friend
Neighbor
Other Relative
Parent
Pastor/Clergy
Roommate
Sibling
Spouse/Partner
Teacher/Counselor
Youth Service Organization
3.
On a scale of 1-10, with 1 being not well at all and 10 being extremely well, how well do you know the volunteer
?
1
2
3
4
5
6
7
8
9
10
4. In a few words, how would you describe their personality?
5. Please tell me about their general strengths and weaknesses?
Strengths
Weaknesses
6. Do you consider them to be dependable and accountable?
Yes
No
7. Can you tell me about a time in which you observed this applicant interacting with youth or young adults? How would you say the applicant relates to them?
8. Have you ever had any reason to be concerned about the applicant’s interaction with youth or young adults? Please explain.
9. How does (
volunteer name
) deal with rules and authority?
10. Have you ever witnessed the volunteer display any concerning interactions with children/youth?
11. Do you know of any reason why being a Big Brother or Big Sister may not be the right volunteer experience for the volunteer?
Yes
No
If so, why?
12.Do you feel like the volunteer can commit to the duration of the program
Yes
No
If not, why?
13. We ask for a one year commitment, do you think the volunteer can do this?
Yes
No
14. How would you describe their time management skills, punctuality, and follow-through?
15. Is there anything else you’d like to add about the volunteer?
Adult Site Based Reference Form
Adult Site Based Reference Form