Dear Community Member,
The applicant named below
has expressed interest in becoming a volunteer with Sexual Assault Support
Services. The Agency is dedicated to supporting victims/survivors in their
effort to heal from the trauma of sexual assault and childhood sexual abuse,
while striving to prevent the occurrence of sexual violence in local
communities and in society at large. Direct Service Volunteers train to provide
support and information on our 24 hour Hotline, and accompany survivors to the
hospital, police station, and/or court.
Education Volunteers train to present prevention programs to students.
Your name was given by the
applicant as someone who would be familiar with the applicant’s
qualifications. Your assistance in
furnishing us with the information requested would be greatly appreciated. A return envelope is enclosed for your
convenience. We appreciate your prompt response.
Sincerely,
X Smith, Volunteer
Coordinator
PERSONAL REFERENCE FORM
Name
of Applicant:__________________________________________
Please return by:___________
Name
of Reference:__________________________________________ Phone:(____)_____________
Circle or Check All That Apply For Each Question
1. What is the
nature of your relationship with this applicant?
Employer Friend
Neighbor Family friend Counselor Teacher
Relative Co-worker Other:______________________
2. How long have
you known the applicant?___________________
3. How well do you know the applicant? Very well Fairly well Not well
4. Please give
your opinion of the applicant in the following areas. Use a scale of 1-10, with 10 being the
highest rating. Use d/k (don’t know)
where applicable.
_____written communication _____oral communication _____
dependability
_____non-judgmental _____listening
skills _____compassion
_____emotional stability _____sense of humor _____public
speaking
_____teamwork _____accepts
criticism well _____social skills