2026 CISV USA Austin Chapter Staff Leader Reference Form

Confidential Reference Form for CISV Leadership / Staff Position

(The only official text for this form is this English edition)

1. Applicant's information

Name

Given nameSurname

Position applied for

Mobile Number (country code / area code / number)

Email address

2. For reference to complete

Dear reference, the person named above has applied for a volunteer leadership position in a CISV programme. He / she will work with international youth from several nations and cultural traditions. During the CISV programme, the applicant will serve as a role model in our peace education activities and work to create an environment where cross-cultural friendships and international cooperation are possible. The applicant will be in a position of trust as friend, educator and guardian of the youth participating in the CISV programme noted below. (CISV programme and position description describing the duties relative to this application have been attached by the applicant.

Please complete the form in English for international positions or, it can be in the language of Applicant for a position in that person's own country. CISV programme officials, the parents and the participating youth thank you for your assistance in selecting appropriate personnel for CISV's international peace education programmes.

Your response will be treated as private and confidential and destroyed as provided by law.

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

Reference is a member of CISV (Indicate Yes or No)

Reference has known the Applicant for the following number of years

Reference sees / communicates with the applicant:

Reference's relationship with applicant

If Other above please specify relationship

Reference’s information

Name

Given nameSurname

Number & street

Town / city

Area / state / province

Country

postcode / zip code

Telephone (country code / area code / number)

Mobile phone (country code / area code / number)

Email address

In my opinion, CISV Would / Would Not benefit by having this applicant in a position of responsibility in its cross cultural and international peace education programmes for the following reasons listed below:

Reasons for recommending the individual:

Special skills or other comments

Declaration

To the best of my knowledge, the information I have provided about the applicant is true, accurate and complete. I am not aware of past/present behaviour by the applicant that would disqualify him/her from working with international youth, acting as an appropriate role model or functioning in a position of trust with CISV

Reference's signature

Signature Date:

Date

(day / month / year)