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Volunteer Online Reference

Volunteer Reference Form

Date
Date Format: MM slash DD slash YYYY
Potential Volunteer Name*
First Last
Person Submitting Reference*
First Last
Your email address*
Your Phone Number*
Phone Type*
How long have you known this applicant?*
In what capacity do you know the applicant?*
Provide more detail about your relationship to the applicant.*
Personal example: This is my best friend, we met in high school. Professional example: This is my boss, I've known her for 5 years and have reported to her for 2 years.
When was the last time you had contact with the applicant?*
Describe the applicant, selecting all that apply.*
- Aggressive
- Assertive
- Confident
- Conscientious
- Cooperative
- Creative
- Domineering
- Empathetic
- Even-tempered
- Flexible
- Follower
- Friendly
- Gregarious
- Happy
- Hot-tempered
- Impatient
- Insecure
- Insensitive
- Lacks confidence
- Leader
- Loner
- Loyal
- Moody
- Nervous
- Opinionated
- Outgoing
- Passive
- Patient
- Reserved
- Responsible
- Rigid
- Secure
- Shallow
- Shy
- Sincere
- Stable
- Temperamental
- Uncooperative
- Unhappy
- Unimaginative
- Unstable
- Well-adjusted
Do you feel the applicant will hold to a one year commitment?*
Applicant's ability to work toward long term goals?
Applicant's reaction to people who are physically ill?
Applicant's reaction to people who are emotionally /mentally ill?
Applicant's adherence to basic rules?*
Is the applicant responsible?*
Is the applicant dependable?*
Is the applicant sensitive to others' needs?*
Is the applicant able to communicate well with others?*
Applicant's problem solving skills?*
Applicant's ability to handle stress or adverse situations?*
Applicant's time management skills?*
Do you recommend this applicant to be a Compeer volunteer?*
Please describe any reservations or concerns you may have about this applicant.
Additional comments or feedback:
Would you like to receive additional information? Check all that apply.
- Client Referral Information
- Compeer Newsletter
- Donation Information
- Volunteer Opportunities
Please supply your mailing address if you wish to receive additional information by mail:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Thank you for taking your time to fill out this reference form. Prospective volunteers are require to submit references before becoming a volunteer and your input is valuble to this process. If you would like to discuss this information in greater detail please contact Lisa Johnson, Director of Volunteer Engagement at (716) 883-3331 ext. 312 or lisa@compeerbuffalo.org.

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Compeer

24 Ludington Street
Buffalo, New York 14206
(716) 883-3331
staff@compeerbuffalo.org

About Us

Compeer recruits, screens, and matches trained volunteers and mentors in one-to-one supportive friendship relationships with children, adults, military veterans and seniors who are striving for good mental health.

Compeer’s Purpose: Promoting good mental health through meaningful friendships.

Values: Respect • Trust • Hope • Support • Empowerment

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