Significant Other/Partner Reference Big Brothers Big Sisters of Miramichi Significant Other/Partner 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 your partner?*2. Did you know your partner was applying to be a mentor?* Yes No If so, what was your reaction?*3. Are you supportive of your partner’s application to become a mentor with Big Brothers Big Sisters?* Yes No 4. What is it like to have the applicant as your partner?*5. How much free time does your partner have?* 6. What personal strengths do you feel your partner has to offer?*7. Based on your knowledge of who your partner has in his/her life, to whom would he/she be most likely to turn, or be most responsive to, for support or guidance?*8. Can you tell me about your partner’s community involvement and personal interests*9. Can your partner be counted on to follow through on the commitments he/she undertakes* Yes No Please explain*10. When have you witnessed your partner interacting with children? How does s/he interact with or relate to children?*11. Have you ever known your partner to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?* Yes No If so, please explain*12. To your knowledge, has your partner ever had any trouble following rules?* Yes No If so, what kind of rules?*13. Are you aware of any complaints being made or disciplinary actions being taken against your partner?* Yes No Please explain*14. Is there anything that you are aware of that may interfere with your partner’s ability to mentor or that would cause their commitment to our organization to come to an end?* Yes No Please explain*15. Has your partner experienced an addiction, health or emotional concern that may impact his/her ability to participate actively in a match?* Yes No If so, what?*16. Would you recommend your partner as a mentor for a child or youth?* Yes No 17. 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 Would you like us to contact you with information about how YOU can get involved?* Yes No Today's Date MM slash DD slash YYYY Δ
