Tutoring Volunteer Reference Form

Thank you for filling out this reference form on behalf of someone applying to be a volunteer Tutor/Mentor with the Chicago Lights Tutoring Program. The applicant will be volunteering with students in 1st-12th grades, supporting them with their academic and social-emotional needs. If you would like to learn more about the program, please visit www.chicagolights.org/tutoring/.

Please fill in the name of the person you are providing a reference for:

How long have you known the applicant?

What is your relationship with the applicant? (friend, co-worker, etc.)

In a few sentences, please describe the character and personal qualities of the applicant.

Please rate the candidate on the following characteristics with this scale:
5 = Very High
4 = High
3 = Neither High or Low
2 = Low
1 = Very Low

Do you know of any reason why this person should NOT be working closely with children?

YesNo

If yes, please describe why:

Would you trust this person with your own children if you have them?

YesNo

If no, please describe why:

By entering my name below, I agree that the information I have supplied on this reference form is correct to the best of my knowledge. I understand that this document is confidential and that the applicant has waived any right to inspect this information. I have been as truthful and forthcoming as possible.

Name

Date

We will only contact about this reference, if needed. Your information will not be shared.

E-mail

Phone

Contact Information

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Dependable
Flexible
Kind
Positive Role Model