2024 Leader/Junior Counselor Reference
An adult or junior counselor applicant has applied for a volunteer leadership position in a CISV Pittsburgh program. He/she will work with international youth from several nations and cultural traditions. During the CISV program, the applicant will serve as a role model in our peace education activities and work to create an environment where cross-cultural friendships and international cooperation are possible. The applicant will be in a position of trust as a friend, educator and guardian of the youth participating in the CISV program.

Leaders will be responsible for a delegation of 4-6 children ages 11-15, depending on the program. A leader helps prepare the children prior to the program, travels with them to/from an international or sometimes domestic destination, works with other leaders and program staff and is responsible for the children in the Pittsburgh delegation at all times.

CISV Pittsburgh officials, the parents and the participating youth thank you for your assistance in selecting appropriate personnel for CISV's international peace education programs. Your response will be treated as private and confidential.

CISV does not consider individuals exhibiting the following behavior to be appropriate for a position of leadership:
alcohol/drug abuse, serious criminal convictions, dishonesty, emotional or behavioral disturbance, prejudice, sexual abuse, violence, lack of self-control, intolerance, or the inability to appropriately deal with stress.

If you have concerns about this applicant or would like to discuss this applicant further, please contact Chuck Murphy at pittsburgh@cisvusa.org.
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Your Name (first and last) *
Address (street, city, state, zip) *
Telephone number *
Email address *
Are you a member of CISV *
Name of Leader/JC Applicant you are referring *
How long have you known the Applicant? *
How often do you see or communicate with the Applicant? *
Your relationship with the Applicant is: *
Required
In my opinion, CISV would benefit by having this Applicant in a position of responsibility in its cross-cultural and international peace education program. *
Please give a detailed description to the opinion given above. *
Please describe the leadership qualities you believe the Applicant possesses that would enable a successful program experience for delegates under his/her care. *
For Program Leader Applicants: Please explain why you feel this Applicant is responsible enough to take children to an international or national destination. *
Please list any special skills or other comments regarding the Applicant, which may be important for the Selection Committee. *
To the best of my knowledge, I have provided information about the Applicant that is true, accurate and complete. I am not aware of any past/present behavior by the Applicant that would disqualify him/her from working with international youth, acting as an appropriate role model or functioning in a position of trust with CISV. *
Please date and submit your reference below. In doing so, you are confirming that what was said in the reference remains true and that your opinion on the matter has not changed. *
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