Reference Form for CISV DFW Leader/JC

Reference Form for CISV DFW Leader/JC
Applicant Name

First NameLast Name
The applicant is applying for (please select one):

Junior Counselor (age 17-17)Leader (age 21+)
The person named above has applied for a volunteer leadership position in the CISV program. The applicant will work with international youth from several nations and cultural traditions. During the CISV program, the applicant will serve as a role model in our peace educational activities and work to create an environment where cross-cultural friendships and international cooperation are possible. The applicant will be in a position of trut as a friend, educator and guardian of the youth participating in the CISV program. CISV program volunteers, parents, and participating youth thank you for your assistance in selecting appropriate personnel for CISV's international peace education programs. Your response will be treated as private and confidential.

CISV does not consider persons exhibiting the following behavior to be appropriate for a position of leadership: alcohol abuse, serious criminal convictions, dishonesty, emotional or behavioral disturbance, prejudice, sexual abuse, violence, lack of self control, intolerance, or the inability to appropriately deal with stress.

This form must be submitted no later than Friday, January 10, 2025.

If you have any questions about this form, please email CISV DFW at dfw@cisvusa.org.
Reference Information

Please provide information about the person completing the recommendation below
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you ever been involved with CISV or known anyone who participated in CISV programs?
Occupation
Phone Number
Please enter a valid phone number.
Email
example@example.com
Capacity in which you know the applicant:
If you are the youth applicant’s current teacher, what is your school’s name?
Length of time you have known the applicant:
In my opinion, CISV would benefit from having this applicant in a position of responsibility in its cross-cultural and international peace education programs.
Please provide more information about your selection above.
Do you know of any special talents or experiences that would help this applicant contribute to an international program?
Declaration and Signature
The information provided above has been thoughtfully and honestly given, based on my knowledge and perception of the youth applicant. I understand that the information will be kept confidential and will be used by the local CISV Chapter in the evaluation of the applicant. I am not aware of past/present behavior by the applicant that would disqualify him/her/them from working with international youth, acting as an appropriate role model or functioning in a position of trust with CISV.
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Reference Form for CISV DFW Leader/JC

Reference Information

Declaration and Signature