This form is intended for past or current employers of a practicum student applying for a placement in the B You: Healthy Bodies, Healthy Minds (formerly “Go Girls”) program. In this practicum role, the successful candidate(s) will have opportunities to volunteer with the youth in our programs. For this reason, and for your convenience, the practicum reference and volunteer reference forms have been combined.

B You Practicum Student and Volunteer Combined Employer-VS Reference Form

About You

Your Name:(Required)

About the Applicant

Name of person reference is being provided for:(Required)
Would you recommend the applicant as a mentor for a child or youth?
Please specify if the applicant has worked with one or more of the following vulnerable populations within your business/organization:
What is/was the role of the applicant with your business/organization?
Does/did the applicant report directly to you?
Did the applicant take on more responsibility or additional roles as time passed?
Can the applicant be counted on to follow through on commitments?
To your knowledge, has the applicant ever had any trouble following rules?
Are you aware of any complaints being made or disciplinary actions being taken against the applicant?
Have you ever known the applicant to be emotionally, physically, verbally or sexually inappropriate with either adults or children?
This field is for validation purposes and should be left unchanged.

Please contact Kait Burns at or 250-475-1117 ext. 50 should you have any questions or concerns.