Students Reference Form

Your Name*

Your Email Address*

Applicant's Name*

Today's Date*

How long have you known this applicant?*

What is your relationship to the applicant?*

How would you rate applicant's ability to work with and relate to children?*

Above satisfactory

Satisfactory

Below satisfactory

Can you give an example of how the applicant relates to children?*

Do you know if the applicant has worked with children in the past? If so, what type of work or services with children has the applicant provided? Example: little league coach, mentor, etc.*

We are looking for someone who can stay calm and control frustration even under very frustrating conditions with children. How would you rate the applicant's ability to be patient and calm?*

Above satisfactory

Satisfactory

Below satisfactory

Have you ever known the applicant to use harsh or abusive discipline with a child? Do you know of any reason the applicant would pose a danger to any child?*

Would you be comfortable placing one of your own children in the care of the applicant? Why or why not?*

What are the applicant’s hobbies and recreational activities?*

How would you rate the applicant’s ability to relate with adults?*

Above satisfactory

Satisfactory

Below satisfactory

Can you give me an example of how the applicant relates with adults?*

We need a person who can be supportive and understanding to a child or student. How would you rate the applicant’s ability to be genuinely supportive and understanding to a person in need?*

Above satisfactory

Satisfactory

Below satisfactory

If you can think of a time when the applicant was able to show genuine concern for a person who needed comfort, please tell about that time.*

Do you have any additional comments or questions?

I hereby declare that the above made statements are true to the best of my knowledge and belief*

Agree

Please leave this field blank.