Online Appointments

Use our form

Visitor Information


Make an Appointment


Patient Services
CSE Search Patients
Home > About > Volunteering > Junior Volunteer Applicant Reference Form

Junior Volunteer Applicant Reference Form

Use this form to provide a reference for a person applying to the junior volunteer program at UVA Health System.

Your reference helps us decide whether to accept this applicant as a junior volunteer. Please rate this candidate in each of the following categories and answer the two questions below. We will not share your responses with the applicant. 

/ /  
Applicant Rating
Not all teens are outstanding in every area. Given the number of teens you interact with, please indicate where this applicant falls in each of the areas below. (For instance, the top 10 percent of this age group might get “Excellent.”)
Fulfills commitments  


Relates to diverse populations  

Emotional maturity  

Verbal communication  

Takes initiative  


Follows instructions  

Manages stressful situations  



Thank you for your input.

Make a Gift

Support continued excellence in patient care, research and education.

Give to the UVA Health Foundation today.