Personal Reference Information

Your name has been given to us as a reference for a potential applicant in our mentoring program at Rise Up! We would appreciate you answering a few questions concerning the applicant. Your responses concerning him/her will be held in absolute confidence, and they will not be shared or accessible to him/her. Thank you so much for your time.

Applicant Name (required)

Date (required)

Your Name (required)

Your Phone Number (required)

Your Email (required)

How long and in what capacity have you known the applicant? (required)

How does the applicant relate to people in general? (required)

How would you describe the applicant? (required)

Do you feel that the applicant would be a good mentor and role model to a child? (required)

Do you think that the applicant relates well to children and young people? (required)

Does the applicant usually keep his or her commitments? (required)

Is he or she on time for appointments and events? (required)

To your knowledge, has the applicant ever been convicted of a crime? (required)

Do you know of any problems or issues that would affect the applicant's ability to spend time alone with a child? (required)

Would you feel comfortable allowing the applicant to spend time alone with your child? (required)

Do you have any additional comments about the applicant? (required)

Have you ever thought about mentoring, and if so, can we send you some information?

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