Reference Form • Personal • Internship with Loom International
Information from this reference form will help the Loom International team to process the application of an internship applicant. The information provided will be used to determine eligibility for an internship with Loom and will only be used for screening and administrative purposes. Please complete ALL requested information! When completed click the submit button at the bottom of the form. Your personally identifiable information is not shared beyond the scope of this application process. For more information and/or to send any additional items as email attachments, address them to:  

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Applicant's Name: *
First and last name
Email Address of Applicant: *
To the Reference:
The person above is applying to intern with the Loom International home office in Portland, Oregon, USA. If accepted, this person will be involved in bringing people, resources, training and information together for the benefit of women and children at risk. This will include working in a cross-cultural environment, and the possibility of travel.

Please appraise the applicant’s strengths and limitations in relation to their potential work with Loom. Feel free to make additional comments on an attached sheet of paper uploaded below or returned via email at
This portion is to be filled out by the Reference:
Reference Name:
City & State, Country:
Phone Number:
Email Address:
How long have you known the applicant? (years/months)
1. What is the nature of your relationship to the applicant? *
2. What are the first words that come to mind to describe the applicant? *
3. Please describe how you have observed the applicant interacting with others and/or working in a team. *
4. Would you describe the applicant as receptive to feedback and constructive criticism? Please explain. *
5. Please describe the applicant’s degree of maturity and self-motivation. *
6. How would you evaluate the applicant’s communication skills, both in articulating ideas and concepts, and their ability to resolve conflict? *
7. Is the applicant willing to try new things, and is she/he open to new people and experiences? Please give examples. *
8. Please describe the applicant’s strengths: *
9. Please describe the applicant’s limitations: *
10. Would you have any reservation in recommending this applicant to work with Loom? If yes, please explain. *
11. Please use this space to include anything else about the applicant that might be helpful in determining her/his qualifications. *
Reference Name/Signature. Your signature indicates that all the information you have entered in this reference form is true and accurate. (Typing your name will serve as your signature in digital format.) *
Date *
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