Significant Other Reference Reference Name* Reference for...* How long have you known your partner? Did you know your partner was applying to be a mentor? Yes No If so, what was your reaction? Are you supportive of your partner's application to become a mentor? Yes No What is it like to have the applicant as your partner?How much free time does your partner have? What personal strengths do you feel your partner has to offer?Based on your knowledge of your partner, to whom would he/she turn to for support or gudiance? Can you tell me about your partner's community involvement and personal interests?Can your partner be counted on to follow through on the commitments he/she undertakes? Yes No When have you witnessed your partner interacting with children? How does the applicant interact with or relate to children?Have you ever known your partner to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children? Yes No If so, please explain: To your knowledge, has your partner ever had any trouble following the rules? Yes No If so, what kind of rules? Are you aware of any complaints being made or disciplinary actions being taken against your partner? Yes No Is there anything that you are aware of that may interfere with your partner's ability to mentor or that would cause their commitment to our organization to come to an end? Yes No Has your partner experienced an addiction, health or emotional concern that may impact his/her ability to participate actively in a match? Yes No Would anything need to change in your home environment to be suitable for a child's visit? Yes No Would you recommend you partner as a mentor for a child or youth? Yes No Is there anything else you would like to add that would aid us in our decision?CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Facebook Twitter Google+ LinkedIn
