CISV Leader Reference Form

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The following reference is for an applicant applying for a CISV Washington DC program. The local CISV USA Chapter requests your help in identifying applicants who exhibit leadership qualities and can represent the USA successfully. References should be from current/past employers, professors, other volunteer organizations leadership etc.

Applicant's First & Last Name *

Applicant's Email address *

The Applicant is seeking appointment as (check the correct position below): *

Leader (Village, Step Up, Interchange, Youth Meeting)

Village Junior Counselor

Other:

Required

The applicant has provided CISV program and leadership description to referee. *

Yes

Required

Referee has known the applicant for: (indicate months or years) *

Referee sees/communicates with the applicant: *

Often

Sometimes

Seldom

Required

Referee's relationship with applicant: *

Work Supervisor

Family Friend

CISV Member

Teacher/Professor

Personal Friends

Co-Worker

Relative

Student

Other:

Required

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