2021-2022 DIAL/SELF AmeriCorps Program - Reference for Member Application

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The DIAL/SELF AmeriCorps Program serves youth in the Pioneer Valley of Western Massachusetts. For ten-months, 19 DSAP members use arts, positive youth development and a student-centered approach to support young people's autonomy, belonging and personal learning aspirations. Members participate in weekly trainings and work together on a team service project in collaboration with the communities they serve.

AmeriCorps engages more than 75,000 Americans a year in results-driven service sponsored by thousands of local and national nonprofits, public agencies, and faith-based and community organizations. AmeriCorps members help communities meet critical challenges in the areas of Disaster Services, Economic Opportunity, Education, Environmental Stewardship, Healthy Futures, and Veterans & Military Families. In return, AmeriCorps members may earn an AmeriCorps Education Award that helps pay for college or pay back student loans.

An applicant has indicated that you would be able to evaluate his/her/their qualifications and provide us with a candid recommendation. The success of DIAL/SELF largely depends upon an appropriate match between the program and members. Please respond to the following questions honestly and completely. Considerable value is placed on personal references during the application review and selection process. Your input is greatly appreciated.

Applicant First and Last Name: *

Applicant Email Address: *

Reference First and Last Name: *

Reference Email Address: *

Reference Phone Number (xxx) xxx-xxxx: *

Reference Position Title/Affiliation (Organization, Business, School, Program, etc.)

Reference Questions

Please respond to these questions directly on this sheet, or email a letter to Allison Scott, ascott@dialself.org

1) How long have you known the applicant, and in what capacity?

2) Please comment on the applicant's accountability (i.e. reliability, ability to work independently, take initiative, adapt to challenging situations, act appropriate to context).

3) Please comment on the applicant’s capacity for youth work and ability to be a good role model.

4) Please comment on the applicant's character, relationships with others (i.e., peers, colleagues, and supervisors) and ability to work as a member of a team.

5) Do you have any reservations at all about recommending this applicant for a term of AmeriCorps service? If yes, please explain.

6) Is there any other information you would like us to consider in evaluating this applicant’s ability to serve as a DIAL/SELF AmeriCorps Member?

Confidentiality Statement *

I AUTHORIZE DIAL/SELF AmeriCorps 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 DIAL/SELF 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.

I certify that all of the statements made in this reference are true, correct, and complete, to the best of my knowledge. *

Check this box to certify that you are the person listed as the reference, and agree with the statement above.

Required

Date: *

YYYY

Thank you for submitting a reference for an applicant of the DIAL/SELF AmeriCorps Program!

For more information, feel free to visit our website: www.dialself.org/americorps.html or email: ascott@dialself.org or call: (413) 774-7054 ext. 101.

DIAL/SELF AmeriCorps serves the communities of Western Massachusetts in partnership with the Massachusetts Service Alliance, the State Commission on Community Service.

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