Safe Environment Reference
The Archdiocese of Oklahoma City requires references to accompany their application to volunteer at The Blessed Stanley Rother Shrine. Please complete this reference if you are over 18 years of age, not a family member of the applicant, priest, deacon or member of a religious order. If you have any questions please contact, Jamie Weathers at (405) 438-0308 ext. 1505.
Name of applicant
Person you are submitting this form for
How many years have you known the applicant?
example: 23
What is your association with the applicant?
Friend, co-worker, neighbor, etc.
Have you observed him/her working with young or the elderly?
Has he/she ever spoken to you about their involvement in the church?
Based on your opinion, will this applicant work well with young people or the elderly?
Do you know anything about this applicant which we should consider in deciding whether to allow him/her to work with the youth or the elderly?
Your Name
First Name
Last Name
Your Email
example@example.com
Your Phone Number
Please enter a valid phone number.
Your occupation
Your E-Signature
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Continue
Should be Empty: