PREPARES Volunteer Reference Form

Hello! A potential PREPARES volunteer gave us your name as a reference. Because our program provides services to a vulnerable population, we administer a Washington State Patrol background check as well as three reference checks. Please complete the following form and submit it to us as soon as possible.

PREPARES is a parish-based pregnancy and parenting support program of Catholic Community Services. This initiative is a nurturing response from the Catholic community to provide parish-based services as a means of supporting families. As a volunteer, the applicant would be offering support to pregnant women, fathers and families with children under the age of 5.

Who are you completing a reference for? (First and last name)*

Applicant's Parish*

Your Name*

First and Last

Phone Number*

E-mail Address*

example@example.com

How long have you known the applicant? *

ex. 3 years, ex. 8 months

In what capacity have you known the applicant?*

(Co worker, friend, etc.)

How frequently do you have contact with the applicant?*

Have you ever seen this applicant work with children?*

YesNo

If so, please explain in what capacity.

How do children respond to him/her/them?*

Would you leave a child close to you in this person's care?*

YesNoOther

Have you had any significant negative experiences with the applicant? If yes, please elaborate.*

Do you have any concerns about the applicant working one-on-one with a child? If yes, please elaborate.*

Please rate the applicant on a scale of 1 to 10 (one being the lowest, ten being the highest) on the following characteristics.

Being a role model*

Dependability*

Enthusiasm*

Ability to work well with people from other cultures or beliefs*

Patience*

Communication skills*

Please provide any additional information which may be relevant to this applicant becoming a volunteer with PREPARES.

Thank you for your time!

For questions or more information, please do not hesitate to contact prepares@ccsww.org - 206.737.9264 - PREPARES of Western Washington | Catholic Community Services | 100 23rd Ave S | Seattle, WA 98144