Name of Applicant 1. 2. 3.

Catholic Charities Diocese of Metuchen Connections Program Personal Reference

Date:

How long have you known the applicant? What is your relationship to the applicant? When did you first learn about the applicants interest in the Connections Program?

4.

In your best estimation, do you feel the applicant is genuinely committed to becoming a volunteer? Ye s No Yes No

5.

Have you been to the applicants home? If yes, how often?

6.

Are you familiar with the applicants relationship with children or young people? Ye s No Please describe

7.

Please rate each of the following: Responsibility Maturity Work attitude Flexibility Dependability Ability to work with others Ability to accept criticism Ability to accept supervision Ability to set limits Self-discipline Communication skills Time-management

Excellent

Good

Fair

Poor

Unknown

8.

Do you have children of your own?

Ye s

No Ye s No

If yes would you allow the applicant to a role model for your children? 9. How would you describe the applicant? (Check all that apply.) Easy-going Follower Warm Moody Quiet Demanding

Forgetful Organization

Lax Loner

Leader Unreliable Responsive Aggressive

Strict Confident Careless

10.

Insecure Creative Stable Spontaneou Compassionat Impulsive s Patient e Blunt Describe your perception of the applicants strengths and limitations as an adult volunteer for youth. What qualities and/or values does the applicant possess which would qualify her/him for our program?

Depressed Friendly Outgoing Considerat e

Messy Opinionated Belligerent

Aloof Happy Tense

11.

Discuss any problems concerning the applicant, which would suggest that she/he would not be a suitable volunteer.

12 .

Do you recommend the applicant as an adult volunteer for youth? Yes, without reservation. Yes, with some reservation. Please explain below.

No, Please explain:

I dont know their potential well enough to make an accurate recommendation. Name: Signature: ____________