After-school Staff Reference

Name of Applicant *

First

Last

Your Name *

First

Last

Relationship to applicant: *

Please explain: *

How long have you known the applicant? *

Your phone number: *

Your email *

Email

Confirm Email

We will email or telephone you to follow up and confirm the reference. Please make sure you use an email and telephone number you can be reached at during the day.

Applicant Evaluation

Displays emotional maturity and stability *

Comments

Accepts guidance, supervision, and feedback *

Comments

Demonstrates mature contact in peer relationships *

Comments

Makes good decisions, keeps self safe and other safe *

Comments

Desires to put the needs of others ahead of their own *

Comments

Is socially aware, tactful, and non-judgemental *

Comments

Is able to guide and motivate children *

Comments

Respects organizational boundaries and policies *

Comments

Please describe what you have observed when this applicant has worked with children/teens in a leadership role. *

Would you entrust the applicant with the direct care and influence of your child? *

Yes
No

Comments

Are there any characteristics which might reduce the effectiveness of the applicant in the camp program or community? *

Yes
No

Comments

Has the applicant proven to you that he/she can control their emotions? *

Yes
No

Comments

In what areas would you like to see the applicant grow? *

Are there any additional comments you would like to make about the applicant?