UNIVERSITY OF ILLINOIS EXTENSION
VOLUNTEER REFERENCE FORM
(Print on letterhead)
_________________________________________________________ is applying to work with
girls and boys through the 4-H program and has given your name as a reference.
The mission of the Illinois 4-H Youth Development program is to help youth learn skills for living.
Adult volunteers assist youth to learn by providing an informal learning structure through which
they can establish learning goals, acquire knowledge, practice skills, develop new attitudes, and
learn to apply these skills to new situations.
University of Illinois Extension seeks your assistance in selecting the best qualified people to
serve in leadership roles for youth. We appreciate your prompt completion of this reference
form sharing your candid observations about the applicant. All comments will be treated in a
confidential manner.
Indicate how long and in what capacity or position you have known the applicant.
____________________________________________________________________________
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____________________________________________________________________________
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Please use this checklist to evaluate the applicant’s leadership qualities. Use the following
marketing system: E = Excellent
G = Good F = Fair N = Not known
Understanding of Children
Dependability
Flexibility
Communication Skills
Sense of Humor
Patience
Ability to Organize
Sense of Fairness
Initiative
Respect for others
Enthusiasm
Resourcefulness
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(over)
Please share your impression and knowledge of the applicant’s qualifications for the position by
using specific examples where possible.
1.
Does the applicant have the ability to work in a leadership role with youth? Other adults?
2.
What additional skills, abilities, and attributes does the applicant have that would be helpful
working with youth?
3.
Describe any experience the applicant has had working with ethnic minorities, low-income
audiences, people with disabilities, or cultural differences.
4.
Is the applicant organized in handling records and/or money?
5.
How would you describe the applicant’s general outlook and stability?
6.
Would you be willing to place your son or daughter, or any other child for whom you are
responsible, under his/her leadership? (
) Yes
(
) No
Why?
7. Do you know any reasons why this person should NOT be considered for this position?
(
) Yes
(
) No
Why?
Signature_______________________________________________ Date ______________
Thank You!
Return to:
Date Received________________
UNIVERSITY OF ILLINOIS EXTENSION VOLUNTEER REFERENCE
FORM
FOR TELEPHONE OR FACE TO FACE INTERVIEWS
Reference Name____________________________________ Phone (
)_______________
Address_____________________________________________________________________
Street
City/State/Zip
Applicant’s
Name_______________________________________________________________________
Position(s) Applied for__________________________________________________________
Interviewed by ______________________________________________ Date _____________
The mission of the Illinois 4-H Youth Development program is to help youth learn skills for living.
Adult volunteers assist youth to learn by providing an informal learning structure through which
they can establish learning goals, acquired knowledge, practice skills, develop new attitudes,
and learn to apply these skills to new situations.
____________________________________ is applying to work with girls and boys through a
4-H Youth Development program and has given your name as a reference. I would like to ask
you some questions. Do you have a few minutes? Your comments will be kept confidential.
1.
How long have you known the applicant?
2.
What is your relationship to the applicant?
3.
Have you ever worked with the applicant in another volunteer capacity?
If yes, please describe:
4.
What strengths would the applicant bring to working with youth?
5.
What difficulties would the applicant have in fulfilling these duties?
6.
Is the applicant dependable?
Does the applicant interact well with children? Other adults?
7.
How organized is the applicant in handling records and/or money?
8.
To your knowledge, what experience does the applicant have working with ethnic
minorities, low income audiences, people with disabilities or cultural differences?
9.
How would you describe the applicant’s general outlook and stability?
10. Would you be willing to place your son or daughter, or any other child for whom you are
responsible under his/her leadership?
11. Would you consider this applicant a positive role model for youth? Why?/Why not?
12. Do you know any reason why this person should not be considered for this position? If yes,
please explain:
Thank you. I appreciate your assistance in helping University of Illinois Extension select the best
qualified people to serve in leadership roles.