Reference Form

has applied to become a volunteer with Arizonans for Children, Inc’s Programs. Due to the sensitive nature the programs, we ask that you assist us in evaluating the appropriateness of the above named applicant to become involved with our organization’s clients: children who are victims of abuse or neglect. Please return the completed form to the above address. The information that you provide will be kept confidential and will not be disseminated to anyone. Thank you for your time and assistance.

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

Comments

Do you feel this person has the ability to effectively volunteer with the Tutor/Mentor Program? Why or not? What are this person’s strengths and weaknesses? What reservation, if any, would you have about accepting this person as a volunteer?

Would you be willing to trust this person with the physical and moral well being of your own child?:

Additional comments regarding the appropriateness of this person to volunteer with children in Child Protective Services custody:

Are you aware of any criminal convictions, allegations of child abuse/molestation, drug/alcohol abuse, other? (Please explain.)