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.

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