Winadu Staff Reference Form
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Counselor Candidate's Name:
(First + Last name of the person you are completing this reference for)
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Reference Full Name:
(your First + Last name)
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Your Title/Position:
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Email:
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Phone Number:
(###-###-####)
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Best time to be reached:
(Eastern Time, please)
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How long and in what context have you known the applicant?
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What were the responsibilities this person had in this role?
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Based on your experience with the applicant, please rate them in the following areas:
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1 - Below Average
2 - Fair
3 - Average
4 - Above Average
5 - Outstanding
6 - Unknown
Professional reliability and attitude
Maturity in social and intellectual areas
Support policies of others
Acceptance of constructive feedback
Cooperation with supervisors
Concern for the individual child (if applicable)
Success in teaching/coaching (known or projected)
Group management
Enthusiasm in working with children
Attitude towards work
Consistency in work
Please identify and explain 3-5 traits the applicant has that will make them a role model for boys aged 7-15 yrs old:
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What would you consider to be a standout strength for this person?
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What area(s) would you like to see some growth or development?
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If you had a 10yr old son, how comfortable would you feel placing him in the care of the applicant?
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To the best of your knowledge, does the applicant have any history of actual or alleged child abuse or sexual abuse, or ever been involved or convicted regarding a felony or misdemeanor?
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Considering the applicant will be working with children, please add any additional comments of support or caution:
Reference taken by:
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