Reference Form for New Staff

Your name was provided as a reference for an individual applying to volunteer for Summer Roundup Girl Scout Camp.

Girl Scout adults, in leadership positions, help girls in a troop or camp to have fun while learning new skills, increasing their abilities to work together, managing their own activities, and developing values. Summer Roundup volunteers strive to provide quality programs for girls at camp

Summer Roundup Girl Scout Camp seeks your assistance in selecting the best qualified people to serve as counselors, program leaders, and activity instructors. We would appreciate your prompt completion of this reference form. All comments will be treated in a confidential manner.

Thank you,

Amy Schisler, Director

Please complete the information below:

Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Phone Number *

- Area Code Phone Number

Name of person for whom you are providing a reference: *

First Name Last Name

How long and in what capacity have you known the applicant? *

Please use the checklist to evaluate the applicant's leadership qualities.

Understanding Children *

Excellent Good Fair Not Known

Communication Skills *

Excellent Good Fair Not Known

Ability to organize *

Excellent Good Fair Not Known

Respect for others *

Excellent Good Fair Not Known

Dependability *

Excellent Good Fair Not Known

Sense of humor *

Excellent Good Fair Not Known

Sense of fairness *

Excellent Good Fair Not Known

Resourcefulness *

Excellent Good Fair Not Known

Flexibility *

Excellent Good Fair Not Known

Patience *

Excellent Good Fair Not Known

Initiative *

Excellent Good Fair Not Known

Enthusiasm *

Excellent Good Fair Not Known

Please share your impression and knowledge of the applicant's qualifications for the position by using specific examples of the following:

Applicant's over-all sense of responsibility and follow-through: *

Applicant's ability to work in a leadership role with girls and adults: *

Applicant's ability to be organized and responsible in running a program: *

Applicants experience working with people of various ethnic backgrounds: *

Applicant's experience working with differently abled children: *

Applicant's willingness to take orders from people both older and younger than him or herself: *

Applicant's ability to be a good role model for young girls: *

Additional skills, abilities, and attributes of this applicant:

Would you be willing to place your child, or any other child for whom you are responsible, under his/her leadership? *

Yes No

Why or Why not? *

Do you know any reason why this person should not be considered for this position? *

Yes No

Other things we should know:

Thank you for taking the time to complette this request.

Amy Schisler

Director, Summer Roundup Girl Scout Camp