Volunteer Reference (469)

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CASA Volunteer Applicant Reference Form

Important: Before You Begin

The reference form will take approximately 15-20 minutes to complete. There is an option to Save and Continue Later if needed.
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Thank you for completing this personal reference for:

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Personal Reference Form

(ALL INFORMATION WILL BE HELD IN STRICTEST CONFIDENCE)

1. In what capacity do you know the applicant? For how long?*

2. Do you know how the applicant relates to children?*

Yes

No

If yes, please explain.*

3. Can the applicant separate personal life from volunteer experience? Please explain your answer.*

4. What adjectives best describe the applicant? Please list at least three.*

5. Please read the following list. Do you think the applicant would have any difficulties working with?

Different Racial Groups

Females

Males

A Specific Religious Affiliation

Handicapped

Please explain your answer:*

6. On a scale, how well does the applicant finish projects and activities?*

1 - Very Well

2 - Well

3 - Average

4 - Fair

5 - Poor

Never Observed

7. To your knowledge, has the applicant ever had a substance abuse problem (alcohol or drugs)?

Yes

No

8. Do you feel the applicant is in a position to make a year long commitment to a child?*

9. Would you be comfortable having the applicants serve as a Court Appointed Special Advocate to a child?*

10. Please comment about the skills and/or qualifications this person possesses which may be of specific value in their work as a CASA volunteer.*

11. Do you have any concerns or do you feel there are any potential areas of weakness which may affect his or her performance?*

12. Please use the following text box to provide any additional comments which you think may be helpful for us to evaluate this applicant.*

Sign and Certify

Certify*

I certify that the information provided in this reference is true.

Thank you again for your time! By clicking submit on this form you confirm that the information provided above about the applicant is accurate to the best of your abilities.

Your Name*

First Last

Date

MM slash DD slash YYYY