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Charlottesville Area 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.
Date
Applicant Name
Reference Name
Reference Email
Reference Phone
Relationship to Applicant
Applicant Rating
Fulfills Commitments
Poor
Good/Average
Above Average
Very Good
Excellent
Attendance
Poor
Good/Average
Above Average
Very Good
Excellent
Relates to Diverse Populations
Poor
Good/Average
Above Average
Very Good
Excellent
Emotional Maturity
Poor
Good/Average
Above Average
Very Good
Excellent
Verbal Communication
Poor
Good/Average
Above Average
Very Good
Excellent
Takes Initiative
Poor
Good/Average
Above Average
Very Good
Excellent
Courtesy/Politeness
Poor
Good/Average
Above Average
Very Good
Excellent
Follows Instructions
Poor
Good/Average
Above Average
Very Good
Excellent
Manages Stressful Situations
Poor
Good/Average
Above Average
Very Good
Excellent
Enthusiastic
Poor
Good/Average
Above Average
Very Good
Excellent
Dependable
Poor
Good/Average
Above Average
Very Good
Excellent
How Does the Applicant Handle Stress?
Provide an example of an occasion where the applicant used interpersonal communication skills to deal with a difficult or stressful person or situation.
Outstanding Skills?
Does the applicant have any notable skills to contribute while in the role of junior volunteer?
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 above. (For instance, the top 10% of this age group might get “Excellent.”)
I certify that the Reference Name listed above is the person completing this form.
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