CONFIDENTIAL REFERENCE FORM
Camp Kydnie is a camp designed specifically for children with kidney disease, who are at least 6 years of age. The goal of Camp Kydnie is to provide a normal camping experience, allowing for health and physical limitations, and with an emphasis on positive self-image, independence and self-assurance. Your personal reference is much appreciated in assisting us with obtaining great staff.
Name of Applicant for which you are providing a reference: *
Your answer
How long have you known the applicant? *
Your answer
In what capacity have you known the applicant? *
Your answer
Evaluating the applicant
Please evaluate the applicant in each of the following areas:
Demonstrates age-appropriate maturity *
Demonstrates follow-through *
Is dependable and reliable *
Possesses a strong record of attendance and being on time *
Is accepting of diverse populations *
Willingly takes the role of a leader or follower as needed *
Possesses a positive attitude *
Demonstrates self-motivation *
Is creative and innovative *
What is your overall recommendation? *
Additional Information:
Your answer
Please provide your contact information to include your name, address, telephone number and email address. *
Your answer
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