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Girl Scouts of Minnesota and Wisconsin Lakes and Pines

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Volunteer reference check

A person you know has applied to be a Girl Scout volunteer at Girl Scouts of Minnesota and Wisconsin Lakes and Pines.  As a volunteer she/he will be joining nearly 50 million women and men who have had their lives forever changed because of Girl Scouting. 

We appreciate your prompt participation in the volunteer reference check program.  Please complete the evaluation below.  Feedback from you helps us ensure a quality leadership experience for girls.

The information you provide is confidential and will not be shared with the applicant. If you have any questions or would like to talk about this in person, contact Martha Livingston at the Lakes and Pines Duluth Regional Center at 877 476-6748 or mlivingston@gslakesandpines.org.
Volunteer Name
Your Name
E-mail
What is your relationship to this person? (ie. work, social, etc.)
How long have you known this person?Less than 1 year
Between 1 and 3 years
Between 3 and 5 years
Over 5 years
Have you ever seen this person in a situation where he/she has related to children?Yes
No
If yes, in what capacity and what age/gender of children?
How did the person and the children interact together?
Did you ever have any oncerns as her/his interaction with children?Yes
No
If yes, please explain
Describe your perception of this person. Check all that applyPositive
Negative
Patient
Sense of humor
Honest
Rigid
Reliable
Tolerant
Motivating
Shy
Loses interest in projects
Shows respect for others
Responsible
Outgoing
Flexible
Impatient
Fun-loving
Shows good judgment
Able to work with diverse groups
Do you think this person is capable of handling money responsibly?Yes
No
Please comment on above answer
Do you think this person works well as part of a team?Yes
No
Does this person work well with adults?Yes
No
Is this person reliable/responsible?Yes
No
Is this person punctual?Yes
No
Would you place your child, or any child you were responsible for, in her/his care?Yes
No
Would you recommend this person?Yes
No
If no, why not?
Do you have any additional comments you would like to share?


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