MCCS Volunteer Reference Form

Volunteer Reference Form

Please complete this form for the MCCS volunteer candidate who contacted you. Contact (717) 367-1649 with any questions - thank you!
Volunteer (VIP) Reference Form
Your Name:*

First NameLast Name
Name of the Person you are Referring:*

First NameLast Name
Your E-mail
Your Phone Number

Area CodePhone Number
Date*

MonthDayYear
How long have you known the applicant?*
How have you been personally involved with the applicant? (friend, family, coworker, etc.)*
Do you feel this person would do well working with students?*
Would you trust the applicant to spend time alone with your child?*
Please carefully rate the candidate in the following areas, on a 5-point scale, with 1 low and 5 high:

Cheerfulness*

	1	2	3	4	5

1 is Worst, 5 is Best

Discretion*

	1	2	3	4	5

1 is Worst, 5 is Best

Dependability*

	1	2	3	4	5

1 is Worst, 5 is Best

Initiative*

	1	2	3	4	5

1 is Worst, 5 is Best

Thinks Before Acting*

	1	2	3	4	5

1 is Worst, 5 is Best

Resect for Authority*

	1	2	3	4	5

1 is Worst, 5 is Best

Flexibility*

	1	2	3	4	5

1 is Worst, 5 is Best

Punctuality*

	1	2	3	4	5

1 is Worst, 5 is Best

Enjoyment of Working w/ Children*

	1	2	3	4	5

1 is Worst, 5 is Best

Please use the following space to indicate anything else that may be important for us to know about the applicant and his/her possible involvement with the staff and students at MCCS.
Overall recommendation *
Evaluator's Signature:*

Clear
Should be Empty:

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Volunteer Reference Form