SJC CASA Volunteer Reference Request

You were selected as a reference by a CASA voluntter applicant. CASA volunteers provide information on children who are abused and neglected, making recommendations to the Court as to a child's best interest. This reference form will be used to assess the applicant’s ability to carry out the role of a Court Appointed Special Advocate. Selected applicants will receive a minimum of 30 hours of training and ongoing program supervision. Your information will enable us to assess the applicant's ability to serve as a CASA Volunteer. Please complete and submit this online reference form. Thank you.

(ALL INFORMATION RECEIVED WILL BE HELD CONFIDENTIAL IN EVERY RESPECT)

Reference Name

First NameLast Name

CASA Volunteer Applicant Name

First NameLast Name

In what capacity have you known the applicant?

How long have you known the applicant?

How well do you know the applicant?

Applicant's relationship to own children, if applicable?

Applicant's relationship to youth in general. (Check as many as are applicable)

Applicant's relationship with people in general. (Check as many as are applicable)

How would you describe the applicant's friendships? (Check as many as are applicable)

Check as many of the following as describe the applicant.

To what extent is this applicant aware of his/her shortcomings?

Check those of the following that describe the applicant's temperament?

Do you consider this applicant emotionally stable?

If no, why not?

Select the applicant's ability to be flexible

How does the applicant assume responsibility?

How well does the applicant finish projects or activities begun?

How would you rate the applicant's ability to handle confidential information?

How would you rate the applicant's ability to be objective, not judging other's behavior or lifestyles?

Is this applicant critical or somewhat bothered by different ethnic backgrounds?

If yes, please explain

In your opinion, has the applicant ever had a drug or alcohol problem?

If yes, please explain

Has the applicant ever had his/her driver's license revoked or suspended?

If yes, please explain

Has this applicant ever been accused, arrested, or convicted of a crime?

If yes, please explain

In a few words, please summarize what your overall reaction or feelings are towards this applicant.

Would you be comfortable having the applicant as an Advocate for a member of your family?

If not, why?

Signature

SAN JUAN COUNTY CASA PROGRAM VOLUNTEER REFERENCE REQUEST