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Family Reference Form

Family Reference Form NEW

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Family Reference Form

Big Sisters, BC Lower Mainland is an organization that enrolls volunteer mentors to provide healthy role models to children and youth in our community. Volunteer mentors must provide a stable, positive influence over the period of their volunteer commitment. Many of the resilient children and youth in our programs have experienced challenges in their lives; relying on the consistent presence of a mentor makes a difference in their lives. Likewise, ending this important relationship sooner than expected can have a detrimental effect on the young person. Help us Start Something for our community’s youth by providing a reference that, to the best of your knowledge, is an honest reflection of the applicant and their ability to be a positive influence in the life of a child.

Your responses will remain confidential. Thank you.

Please note: This reference check is required so that we may continue with the application process. Please submit this completed reference check to Big Sisters within 3 business days.

Do not close this browser window before submitting the form, as your progress may be lost. For longer responses, consider saving your work in a Word or text document as you go, just to be safe.

Reference provided for:*

First Last

Date completed*

MM slash DD slash YYYY

Reference provided by:*

First Last

Email*

Phone

Do not close this browser window before submitting the form, as your progress may be lost. For longer responses, consider saving your work in a Word or text document as you go, just to be safe.

How long have you known the applicant and in what capacity?*

Did you know the applicant was applying to become a mentor?*

Yes

No

If so, what was your reaction?*

What personal strengths does the applicant have to offer?*

Based on your knowledge of who the applicant has in their life, to whom would they be most likely to turn to, or be most responsive to, for support or guidance?*

Do not close this browser window before submitting the form, as your progress may be lost. For longer responses, consider saving your work in a Word or text document as you go, just to be safe.

Can you describe the applicant's community involvement and personal interests?*

Can the applicant be counted on to follow through on the commitments they undertake?*

Yes

No

Please explain:*

Have you witnessed the applicant interacting with children?*

Yes

No

If yes, how do they interact with or relate to children?*

Have you ever known the applicant to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?*

Yes

No

If yes, please explain:*

To your knowledge, has the applicant ever had any trouble following rules?*

Yes

No

If so, what kind of rules?*

Is there anything that you are aware of that may interfere with the applicant’s ability to mentor or that would cause their commitment to our organization to come to an end?*

Yes

No

If yes, please explain:*

Has the applicant experienced an addiction, health or emotional concern that may impact their ability to participate actively in a match?*

Yes

No

If yes, please explain:*

Would anything need to change in the applicant's home environment to be suitable for a child's visit?*

Yes

No

If so, what?*

Would you allow the applicant to develop a one-to-one relationship with your child or a child you care about?*

Yes

No

If no, why not?*

Would you recommend the applicant as a mentor for a child or youth?*

Yes

No

If no, why not?*

Do not close this browser window before submitting the form, as your progress may be lost. For longer responses, consider saving your work in a Word or text document as you go, just to be safe.

Is there anything you would like to add that would aid us in our decision?

By typing and signing my name below, I am certifying that all of the information I have provided in this reference form is accurate and true to the best of my knowledge.

Name*

Signature*

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Big Sisters of BC Lower Mainland
Suite 200, 5118 Joyce Street Vancouver, BC V5R 4H1

Phone: 604-873-4525
Email: info@bigsisters.bc.ca
Charitable Business Number: 11880 9409 RR 0001

Copyrights

© 2021, Big Sisters of BC Lower Mainland - BSBCLM Charitable Business Number: 11880 9409 RR 0001

At Big Sisters, we honour that the land on which we work and mentor is the traditional and unceded territory of the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh Úxwumixw (Squamish), səl̓ilw̓ətaʔɬ (Tsleil-Waututh), QayQayt First Nation, Kwantlen, q̓íc̓əy̓ (Katzie), Semiahmoo, Tsawwassen First Nations, kʷikʷəƛ̓əm (Kwikwetlem), and Stó:lō Nation.

1. Are you a self-identified woman, non-binary, transgender or gender-diverse individual (age 19+) interested in becoming a volunteer?

YES
NO