Reference Check Form

This individual is applying to become a mentor with Mid-Ohio Youth Mentoring, and has given your name as a reference. We assure you that your answers will be confidential. This individual will be acting as a role model to a child in our community that we match them with.  The matched pair will participate in various activities, and we are asking this mentor to commit a minimum of 4 hours per month for the next 12 months.  Keeping that in mind, please take a minute or two and let us know a little bit about this individual by answering the questions below.  Thanks for your help!

Your First Name:
Your Last Name:
Applicant / Mentors name: *
How long have you known the applicant?*
How do you know him/her? what is your relationship to them?*
Can you tell us about a time that you observed him/her around a child? and what were your impressions or feelings about those interactions?*
Do you know any reason why being a mentor may not be the right volunteer experience for him/her?*

Do you know any reason why this may not be the right time for her/him to commit to being a mentor?*

Can you give me some descriptive words, or personality traits of this person that will help us find the best child to match them with?*
Is there anything else you would like to tell us about him/her?
Enter the text you see in the security image: