ACLP Mentor Referenece Form
Thank you for taking the time to fill out this reference form. Please complete all sections and use the optional comment section for any additional information you feel is pertinent for us to know when considering this candidate as a mentor for the ACLP Mentorship Program.
Your Name
First Name
Last Name
Your Email
example@example.com
What is your title/position?
Applicant's Name
How long have you known the applicant?
What is your relationship to applicant (e.g., supervisor, colleague, professor, friend)?
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How would you rate the applicant's work ethic and commitment to their goals?
Worst
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Best
5
1 is Worst, 5 is Best
How would you rate the applicant's communication skills (written and verbal)?
Worst
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Best
5
1 is Worst, 5 is Best
How would you rate the applicant's critical thinking and problem-solving skills?
Worst
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Best
5
1 is Worst, 5 is Best
How would you rate the applicant's dependability?
Worst
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Best
5
1 is Worst, 5 is Best
How would you rate the applicant's time management skills?
Worst
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Best
5
1 is Worst, 5 is Best
How would you rate the applicant's professionalism?
Worst
1
2
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4
Best
5
1 is Worst, 5 is Best
Please describe the applicant's key strengths and skills. Provide specific examples wherever possible.
How confident are you in the applicant's ability to mentor other child life professionals?
Is there anything else you would like to share about the applicant that could be helpful?
Do you recommend this candidate as a mentor for the Mentorship Program?
Yes, I recommend
Yes, with reservations
No, I do not recommend
Submit
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