Reference Form : Forms : The Friends Program of Kearney

Reference Name

First Name *

Last Name *

Date

Reference Phone Number

Regarding Big Friend Application

First Name *

Last Name *

How long have you personally known this applicant?

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In what context have you personally known the applicant? (Student, friend of family, church, etc.)

In your opinion, how does applicant get along with children?

How dependable and reliable is the applicant?

In your opinion, is this applicant of good moral character?

To your knowledge, has this applicant been convicted of a crime?

To your knowledge, has this applicant ever abused a child?

To your knowledge, has this applicant ever had a moving vehicle violation?

To your knowledge has this applicant ever had an alcohol or drug problem?

What limits if any, would you put on matching this applicant with a little friend?

Do you have any reservations about recommending this applicant?

Should this application be postponed or denied for any reason?

In your summary judgment, should we approve this applicant for matching with a little friend?

Other Comments

Reference Form