State Potential Mentor Reference

The following individual has applied to be a volunteer mentor with Tarheel ChalleNGe Academy. He/she is being considered for a match in a one-to-one relationship with one of our cadets. The information received by you is kept in strict confidence.

Academy *

Potential Mentor Name *

How long have you known the applicant? *

In what capacity? *

Does the applicant work well with others? *

Yes

Does the applicant have a good home relationship? *

Yes

Does he/she have a tendency to over-commit or get too involved? *

Yes

Please rate the volunteer on the questions below: *

	Poor	Average	Excellent
Compassion for those in need	Poor	Average	Excellent
Concern for young people	Poor	Average	Excellent
Maturity and stability	Poor	Average	Excellent
Ability to respect others with differing views and values from their own	Poor	Average	Excellent
Skillfulness to express an opinion in the face of opposition	Poor	Average	Excellent
Responsibility to use confidential information appropriately	Poor	Average	Excellent
Ability to remain objective in a crisis or conflict situation	Poor	Average	Excellent
Capability to problem solve and reach decisions independently	Poor	Average	Excellent
Openness to learning	Poor	Average	Excellent
Verbal communication skills	Poor	Average	Excellent
Written communication skills	Poor	Average	Excellent
Proficiency to carry out assignments in due time	Poor	Average	Excellent

Do you have any concerns about the suitability of the application or their ability to work with our cadets?

Name *

Reference Email Address *

Phone Number *

Date * +