Reference from Family Member or Partner/Significant Other About YouYour Name:(Required) First and Last Your Phone Number:(Required)Your Email Address: About the ApplicantName of person reference is being provided for:(Required) First and Last Where does this person live?(Required) in the Comox Valley in Greater Victoria on Salt Spring island in Sooke elsewhere/unsure 1. Would you recommend the applicant as a mentor for a child or youth? Yes Let's discuss this over the telephone 2. How long have you known the applicant and in what capacity?3. Did you know the applicant was applying to become a mentor and what is your reaction to the idea?4. What personal strengths do you feel the applicant has to offer?5. Based on your knowledge of them, who do you think the applicant would turn to for support and/or guidance?6. What can you share about the applicant's community involvement and personal interests?7. When you have witnessed the applicant interacting with children, how do they interact and/or relate to them?8. Are you aware of anything that might interfere with the applicant's ability to mentor or would cause their commitment to our organization to come to an end? No Let's discuss this over the telephone 8. Can the applicant be counted on to follow through on commitments? Yes Let's discuss this over the telephone 9. Would you allow the applicant to develop a one-on-one relationship with a child you care about? Yes Let's discuss this over the telephone 11. Have you ever known the applicant to be emotionally, physically, verbally or sexually inappropriate with either adults or children? No Let's discuss this over the telephone 12. To your knowledge, has the applicant ever had any trouble following rules? No Let's discuss this over the telephone 14. Has the applicant experienced an addiction, health or emotional concern that may impact their ability to participate actively in a match? No Let's discuss this over the telephone 15. Would anything need to change in the applicant's home to be suitable for a child's visit? No Let's discuss this over the telephone 16. Is there anything you would like to add that would aid us in our decision?FOR PARTNERS/SIGNIFICANT OTHER'S ONLY: Are you supportive of your partner/significant other’s application to become a mentor with Big Brothers Big Sisters? Yes Let's discuss this over the telephone FOR PARTNERS/SIGNIFICANT OTHER'S ONLY: What is it like to have the applicant as your partner/significant other?FOR PARTNERS/SIGNIFICANT OTHER'S ONLY: How much free time does your partner/significant other have?FOR PARTNERS/SIGNIFICANT OTHER'S ONLY: Are you are of any complaints being made or disciplinary actions being taken against your partner/significant other? No Let's discuss this over the telephone CommentsThis field is for validation purposes and should be left unchanged.
