Personal Reference Form

Personal Reference Form

Reference provided for:*

First Last

Date*

Reference provided by:*

First Last

Email*

Phone

Big Sisters is an organization that enrolls volunteer mentors to provide healthy role models to children and youth in our community. Volunteer mentors must provide a stable, positive influence over the period of their volunteer commitment. Many of the resilient children and youth in our programs have experienced challenges in their lives; relying on the consistent presence of a mentor makes a difference in their lives. Likewise, ending this important relationship sooner than expected can have a detrimental effect on the young person. Help us Start Something for our community’s youth by providing a reference that, to the best of your knowledge, is an honest reflection of the applicant and their ability to be a positive influence in the life of a child.

Your responses will remain confidential. Thank you.

Please note: This reference check is required so that we may continue with the application process. Please submit this completed reference check to Big Sisters within 3 business days to info@bigsisters.bc.ca.

Do not close this browser window to ensure your work is not lost. You may want to save your long answers in a word/text document as you go along, just to be safe.

How long have you known the applicant and in what capacity?*

Did you know the applicant was applying to become a mentor?*

Yes

If so, what was your reaction?

What is it like to have the applicant as a friend?*

What personal strengths do you feel the applicant has to offer?*

Based on your knowledge of who the applicant has in their life, to whom would they be most likely to turn to, or be most responsive to, for support or guidance?*

Can you tell me about the applicant's community involvement and personal interests?*

Can the applicant be counted on to follow through on the commitments they undertake?*

Yes

Please explain:*

When have you witnessed the applicant interacting with children? How do they interact with or relate to children?*

Have you ever known the applicant to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?*

Yes

If yes, please explain:

To your knowledge, has the applicant ever had any trouble following rules?*

Yes

If so, what kind of rules?

Is there anything that you are aware of that may interfere with the applicant’s ability to mentor or that would cause their commitment to our organization to come to an end?*

Yes

Has the applicant experienced an addiction, health or emotional concern that may impact their ability to participate actively in a match?*

Yes

Would anything need to change in the applicant's home environment to be suitable for a child's visit?*

Yes

If so, what?

Would you allow the applicant to develop a one-to-one relationship with your child or a child you care about?*

Yes

If no, why not?

Would you recommend the applicant as a mentor for a child or youth?*

Yes

Is there anything you would like to add that would aid us in our decision?

By typing my name in the line below I am certifying that all of the information I have provided in this reference form is accurate and true to the best of my knowledge.

Name*

Signature*

Personal Reference Form

By typing my name in the line below I am certifying that all of the information I have provided in this reference form is accurate and true to the best of my knowledge.

1. Are you a self-identified woman, non-binary, transgender or gender-diverse individual (age 19+) interested in becoming a volunteer?