VOLUNTEER REFERENCE REQUEST
Menomonie School Mentoring Program
Name of Volunteer Applicant_____________________________________________
How long have you known the applicant?___________________________________
In what capacity have you known the applicant?______________________________
How well do you know the applicant?_______________________________________
How frequent is your contact with the applicant?______________________________
Daily_______ Weekly_______ Monthly_______ Yearly_______
By Phone________ Letter________ In Person_________
Please mark on the continuum where you think the applicant fits best:
Outgoing-----------------------------------------Shy
Patient--------------------------------------------Impatient
Happy---------------------------------------------Unhappy
Confident----------------------------------------Lacks Confidence
Even Tempered----------------------------------Moody
Popular--------------------------------------------Loner
Well Adjusted------------------------------------Troubled
Flexible---------------------------------------------Rigid
Creative--------------------------------------------Unimaginative
Stable-----------------------------------------------Unstable
Empathic-------------------------------------------Insensitive
Assertive--------------------------------------------Passive
Do you think this applicant has any problem areas we should be aware of?
How would you describe the applicant’s relationships with adults?
How would you describe the applicant’s relationships with children?
In your opinion, how responsible is the applicant?
Always_______ Usually_______ Seldom_______ Never_______
Please give an example of how the applicant has displayed reliability.
Please give an example of how the applicant has displayed unreliability.
Please describe your view of the applicant’s judgment.
Excellent_________ Good________ Fair_________ Poor_________
To what extent does the applicant follow through with commitments?
Always_________ Usually________ Sometimes_________ Seldom_________
To your knowledge, has the applicant ever abused the use of alcohol or drugs?
Yes_________ No__________ If yes, please explain_____________________
Do you know of any reason why the applicant would not make a good volunteer?
______________________________________________________________________________
As a parent or potential parent, would you consider placing the responsibility of a child with this person?____________________________________________________________
To your knowledge, has the applicant ever been involved in other youth group programs?
_____________________________________________________________________________
What do you like best about this person?___________________________________________
What do you like least about this person?___________________________________________
Please feel free to add any additional comments or information to the bottom of this form, or to call our office at 235-9552. Thank you!!
Signature_____________________________________Date______________________________