Christ House Year Long Volunteer Reference Form

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Thank you for serving as a reference for an applicant for the Christ House Volunteer Corps for June 2020-June 2021! Christ House is a 24-hour medical respite facility in Washington, DC. We provide comprehensive and compassionate health care for men who are homeless with acute medical needs and offer assistance to help break the cycle of homelessness through medical treatment, addictions and recovery support, mental health treatment, social services, nourishment, and rest.

For over 30 years, we have had the joy of offering transformative experiences for young adults interested in serving and living in community with Christ House. Christ House relies on Year Long Volunteers (YLVs) to help fulfill its mission. YLVs must be dedicated to service, committed to issues of social justice, and open to learning from others and growing.

We appreciate your thoughtful evaluation of the applicant’s qualifications and recommendation of their participation in the Christ House Volunteer Corps. An applicant’s application packet is not complete until all reference forms have been submitted. A timely completion of this form is much appreciated!

Please note that you are not able to save your answers if you only partially complete the form. You also will not be able to edit the form once you have submitted it.

If you have any questions about the Chris House Volunteer Corps, please contact Lydia Olsen, Director of Volunteers, at 202-328-1100 or Lydia.Olsen@christhouse.org. Thank you!

Reference's Background Information

Reference Name *

First and last name

Reference Title/Occupation

Reference Email *

Reference Phone Number *

Reference Mailing Address

Applicant's Information

Applicant First and Last Name *

Applicant's Email Address *

In what capacity are you serving as a reference for this applicant? *

Professional reference: who can speak to the applicant's work ethic and character

Personal reference: who can understand the applicant's motivation for service

Communal reference: a non-family member who has lived with the applicant within the past two years who can offer perspective about the applicant as a potential roommate and community member

Required

How long have you known the applicant? *

How have you observed the applicant's commitment to social justice and service? *

What gifts do you think the applicant would bring to Christ House and to their intentional community? *

What challenges do you foresee for the applicant regarding direct service with the population Christ House serves and/or living in intentional community? *

Please indicate your overall recommendation of the applicant by selecting the appropriate rating below *

Do Not Recommend

Highly Recommend

Please elaborate on any reservations you have about the applicant.

CONFIDENTIALITY STATEMENT:

The Privacy Act is a federal law which states that everyone has the right to know and receive information and copies of documents which are maintained about them by agencies. This law provides that Christ House may keep the identity or the source of this reference confidential only if you request it be kept confidential. Please choose the appropriate selection below to indicate whether you do or do not wish your identity to be revealed to the applicant.

Do you authorize Christ House to identify you as the source of this reference and release a copy of this reference, upon request, to the applicant? By declining authorization, you are prohibiting Christ House from identifying you as the source of this reference and releasing a copy of this reference. You are aware that a summary of your reference may be released. *

I authorize Christ House to identify me.

I do not authorize Christ House to identify me.

Please electronically sign your name. *

Date *

YYYY

Thank you!

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