San Diego Ronald McDonald House- Volunteer Program Reference Form

Thank you for taking the time to fill out this reference form. Your honest evaluation will be a service to the applicant, our volunteer program, and our families at the San Diego Ronald McDonald House. This reference will be kept confidential and will not be seen by the applicant. Please click "Done" at the bottom of this form to submit your reference.

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1. Please enter the VOLUNTEER APPLICANT'S name.
(Please do not list your name here; this should be the name of the person for whom you are supplying a reference.)

First Name

Last Name

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2. Please rate the applicant on the following qualities:

	Superior	Above Average	Average	Below Average	Poor	Not Observed
Exhibits positive attitude	Exhibits positive attitude Superior	Exhibits positive attitude Above Average	Exhibits positive attitude Average	Exhibits positive attitude Below Average	Exhibits positive attitude Poor	Exhibits positive attitude Not Observed
Exhibits tact and diplomacy	Exhibits tact and diplomacy Superior	Exhibits tact and diplomacy Above Average	Exhibits tact and diplomacy Average	Exhibits tact and diplomacy Below Average	Exhibits tact and diplomacy Poor	Exhibits tact and diplomacy Not Observed
Exhibits initiative	Exhibits initiative Superior	Exhibits initiative Above Average	Exhibits initiative Average	Exhibits initiative Below Average	Exhibits initiative Poor	Exhibits initiative Not Observed
Exhibits strong listening skills	Exhibits strong listening skills Superior	Exhibits strong listening skills Above Average	Exhibits strong listening skills Average	Exhibits strong listening skills Below Average	Exhibits strong listening skills Poor	Exhibits strong listening skills Not Observed
Uses appropriate communication skills	Uses appropriate communication skills Superior	Uses appropriate communication skills Above Average	Uses appropriate communication skills Average	Uses appropriate communication skills Below Average	Uses appropriate communication skills Poor	Uses appropriate communication skills Not Observed
Displays understanding of boundaries	Displays understanding of boundaries Superior	Displays understanding of boundaries Above Average	Displays understanding of boundaries Average	Displays understanding of boundaries Below Average	Displays understanding of boundaries Poor	Displays understanding of boundaries Not Observed
Displays understanding of confidentiality	Displays understanding of confidentiality Superior	Displays understanding of confidentiality Above Average	Displays understanding of confidentiality Average	Displays understanding of confidentiality Below Average	Displays understanding of confidentiality Poor	Displays understanding of confidentiality Not Observed
Dependability	Dependability Superior	Dependability Above Average	Dependability Average	Dependability Below Average	Dependability Poor	Dependability Not Observed
Overall evaluation	Overall evaluation Superior	Overall evaluation Above Average	Overall evaluation Average	Overall evaluation Below Average	Overall evaluation Poor	Overall evaluation Not Observed

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3. What is/was your association with the applicant?

Professional (indicate organization and relationship)

Other (indicate relationship)

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4. Would you recommend this applicant work in an environment that involves interacting with families experiencing a medical crisis?

Yes

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5. Additional comments regarding applicant's appropriateness for a volunteer position with the San Diego Ronald McDonald House:

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6. Please provide us with your contact information.

Full Name

Title, if applicable

Telephone Number

Email Address

Street Address

City

State

Zip Code

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1. Please enter the VOLUNTEER APPLICANT'S name.(Please do not list your name here; this should be the name of the person for whom you are supplying a reference.)

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2. Please rate the applicant on the following qualities:

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3. What is/was your association with the applicant?

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4. Would you recommend this applicant work in an environment that involves interacting with families experiencing a medical crisis?

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5. Additional comments regarding applicant's appropriateness for a volunteer position with the San Diego Ronald McDonald House:

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6. Please provide us with your contact information.

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7. Signature: My typed name below shall have the same force and effect as my written signature.

1. Please enter the VOLUNTEER APPLICANT'S name.
(Please do not list your name here; this should be the name of the person for whom you are supplying a reference.)