* 1. Name of client being referred:

* 2. Name of referral agency:

* 3. Name of agency representative:

* 4. Representative phone:

* 5. Representative email:

* 6. Please summarize any significant career planning steps, or career planning goals that you have supported your client through in their pursuit for a better job:

* 7. Briefly list any actions, steps or goals your client has taken, which demonstrates the client’s character, or readiness to work towards a better job:

* 8. Please indicate all known barriers to employment for your client:

* 9. Additional information on the client and their situation:
Do you have any additional information that you believe may be important for their application?

By submitting this form to make this referral you acknowledge the following statements to be true:
  1. You (or your agency) have worked with this person long enough to feel comfortable in making a character referral.
  2. You believe this person has the capacity and desire to repay a Job Boost Loan.
  3. You are in agreement with the individual's proposed Career Action Plan (they suit the chosen path and that path represents an improvement from their current situation).
  4. To the best of your knowledge, all other financing sources have been considered.