Family Reference Big Brothers Big Sisters of Miramichi Family Reference Provided for:*Big Brothers Big Sisters is an organization that enrols volunteer mentors to provide a healthy role model to children and youth in our community. Volunteer mentors must provide a stable, positive influence over the period of their commitment, which is usually a school or calendar year. 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. 1. How long have you known the applicant and in what capacity?*2. Did you know the applicant was applying to be a mentor?* Yes No If yes, what was your reaction?*3. What personal strengths do you feel the applicant has to offer?*4. Based on your knowledge of who the applicant has in his/her life, to whom would he/she be most likely to turn, or be most responsive to, for support or guidance?*5. Can you tell me about the applicant's community involvement and personal interests?*6. Can the applicant be counted on to follow through on the commitments he/she undertakes?* Yes No Please explain*7. When have you witnessed the applicant interacting with children? How does the applicant interact with or relate to children?*8. Have you ever known the applicant to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?* Yes No If so, please explain*9. To your knowledge, has the applicant ever had any trouble following rules?* Yes No If so, what kind of rules?*10. 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*11. Has the applicant experienced an addiction, health or emotional concern that may impact his/her ability to participate actively in a match?* Yes No 12. Would you allow the applicant to develop a one-to-one relationship with your child or a child you care about?* Yes No If not, why not?*13. Would you recommend the applicant as a mentor for a child or youth?* Yes No 14. Is there anything you would like to add that would aid us in our decision?*Please provide the following for file purposes only (will not be used for promotional purposes)Your Name*Your Email* Your Address* Street Address Address Line 2 City Postal Code Best phone number to reach you at*That number is your:* Cell Work Today's Date MM slash DD slash YYYY Δ
