AmeriCorps Reference Form

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Email *

Name *

Phone Number *

Organization (if applicable)

Applicant Name (for whom you are a reference) *

How long have you known the applicant? *

In what capacity have you known the applicant? *

Job Supervisor

High School Teacher

Clergy

Volunteer Supervisor

College Instructor

Coach

Other:

In your judgment, how competent is this applicant, as demonstrated by work in the community, in school, on the job, or in a position of responsibility? Please select one.

Outstanding performance

Above average performance

Satisfactory

Below average performance

Unsatisfactory performance

KNOWLEDGE OF THE APPLICANT: Please describe the situation in which you know the applicant.
*

WORK PERFORMANCE: Please comment on such qualities as the applicant's level of dependability, initiative, and ability to work with minimal supervision and as a member of a team.

RELATIONSHIPS WITH OTHER PEOPLE: AmeriCorps members must serve and communicate with people of varied cultural, economic, educational, racial, and religious backgrounds. Please comment briefly on the applicant's relationships with others and ability to work as a member of a team.

EMOTIONAL MATURITY: Please comment on the applicant's ability to adapt and work under difficult and changing conditions.
*

What is your overall recommendation? *

I recommend the applicant for AmeriCorps service.

I have some reservations, but I believe the applicant will succeed in serving with the AmeriCorps.

I do not recommend this applicant for AmeriCorps service.

AUTHORIZATION *

I AUTHORIZE the program and/or the Corporation for National and Community Service to identify me as the source of this reference and to release a copy of this reference in its entirety upon request to the applicant.

I DO NOT authorize the program and/or the Corporation for National and Community Service to identify me as the source of this reference, nor do I authorize the release of a copy of this reference in its entirety to the applicant.

Send me a copy of my responses.

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