╨╧рб▒с>■  24■   1                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴q ┐2bjbjt+t+ % AA +      ]FFFFFFFvvvv8о╩vю ╢ЄДv"ШШШШЎОТД│ ╡ ╡ ╡ ╡ ╡ ╡ $д ЇШl┘ FШШ┘ оFFШШЄоооFШFШ│ ZhFFFF│ оТо@ У FF│ Шц ╨К}]╤П┴vv&Ил PERSONAL REFERENCE FORM ALL INFORMATION WILL BE HELD CONFIDENTIAL IN EVERY RESPECT (Please Print) FROM: ____________________________ CONCERNING: ____________________________ 1. In what capacity have you know the applicant? _____________________________________ For how long? _________________________ 2. Do you have knowledge of how the applicant relates to children? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If yes, please explain: _________________________________________________________ ___________________________________________________________________________ 3. Can applicant separate personal life from volunteer work experience? ___________________ ___________________________________________________________________________ Check as many of the following that describe the applicant:  FORMCHECKBOX  Domineering  FORMCHECKBOX  Nervous  FORMCHECKBOX Friendly  FORMCHECKBOX  Assertive  FORMCHECKBOX  Tactful  FORMCHECKBOX  Leader  FORMCHECKBOX  Happy  FORMCHECKBOX  Aggressive  FORMCHECKBOX  Considerate  FORMCHECKBOX  Cooperative  FORMCHECKBOX  Reserved  FORMCHECKBOX  Moody  FORMCHECKBOX  Opinionated  FORMCHECKBOX  Follower  FORMCHECKBOX  Well-adjusted  FORMCHECKBOX  Arrogant  FORMCHECKBOX  Unhappy  FORMCHECKBOX  Stubborn  FORMCHECKBOX  Confident  FORMCHECKBOX  Lacks Confidence Would applicants have problems in working with any of the following: Racial minorities  FORMCHECKBOX  Females  FORMCHECKBOX  Males  FORMCHECKBOX  Handicapped  FORMCHECKBOX  Various religious preferences  FORMCHECKBOX  Explain: __________________________________ ___________________________________________________________________________ How well does the applicant finish projects and activities begun? Very well  FORMCHECKBOX  Well  FORMCHECKBOX  Average  FORMCHECKBOX  Fair  FORMCHECKBOX  Poor  FORMCHECKBOX  To your knowledge, has the applicant ever had a drinking or drug problem? ______________ ___________________________________________________________________________ Do you feel that the applicant is in a position to make a year-long commitment to a child? ___________________________________________________________________________ Would you be comfortable having the applicant serve as a Court Appointed Special Advocate to a child? __________________________________________________________ Please use the back of this sheet to add any additional comments summarizing your view of the applicant and their ability to work on behalf of an abused child. ______________________________________ ___________________________________ Signature Date PAGE  Tools PAGE 149 ДЕУФХЪЫйклABPQRcdrstДЕУФХзи╢╖╕╩╦┘┌█фхєЇї  -.<=>NO]^_no}~·Є··ъ··т··┌··╥··╩··┬··║··▓··к··в··Ъ·БjUБjМUБjUБjвUБj.UБj║UБjFUБj╥UБj\UБjшUБjtUБjU jU<STcde▓│ 89мTU▓@AфМ" ╬ ╧  Р ¤·°·°°°°°°°°°°°°°°є°яяяя°єяДh & F$STcde▓│ 89мTU▓@AфМ" ╬ ╧  Р э 9 : | }   h ┤ ╡  \ ] ■ 1¤·Їюшт▄┌                *МНЫЬЭйк╕╣║╞╟╒╓╫цчїЎў     " # 1 2 3 H I W X Y h i w x y К Л Щ Ъ Ы л м ║ ╗ ╝ & ' 5 6 7 C D R S T ·Є··ъ··т··┌··╥··╩··┬··║··▓··к··в··Ъ·БjК UБj UБjЮ UБj( UБj▓UБj<UБj╞UБjPUБj┌UБjdUБjюUБjxU jU@Є*Title$5БCJ ,@,Header  ╞р└!, @,Footer  ╞р└!&)@в!& Page Number2         Х2 &(*-T 2 Р 2 1 ДФЪкAQcsДФз╖╩┌фЇ -=N^n~МЬй╣╞╓цЎ"2HXhxКЪл╗&6CS_o~Оо╛ЗЧг│╟╫▀я№ 2 GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ GХ  "-!Х!Ї ХА   Check1Check2Check3Check16Check5Check6Check7Check8Check9Check10Check11Check12Check13Check14Check15Check17Check18Check19Check20Check21Check22Check23Check24Check25Check26Check27Check28Check29Check30Check31Check32Check33ЕЫBdЕи╦х .OoНк╟ч#IiЛм'D`пИд╚р¤3  ХлRtХ╕█ї>_Э║╫ў3YyЫ╝7TpП┐Ш┤╪Ё 3  3 ЖУuД-зйZh8BЩвя°  ) 3   sybil*C:\TEMP\AutoRecovery save of Document2.asdsybilА\\ncasa1\data\Program Relations- Grant Admin\Guides-Manuals\Program Development\2001 NPD Guide\TOOLS\PERSONAL REFERENCE FORM.docsybilА\\ncasa1\data\Program Relations- Grant Admin\Guides-Manuals\Program Development\2001 NPD Guide\TOOLS\PERSONAL REFERENCE FORM.doccarlaА\\NCASA1\data\Program Relations- Grant Admin\Guides-Manuals\Program Development\2001 NPD Guide\TOOLS\PERSONAL REFERENCE FORM.docкW#          ДhДШ■╞ho(.кW#       @АьВ¤2 P@GРЗzА Times New Roman5РАSymbol3&Р ЗzА Arial"ёМ╨hЧє[ж╕т\ж"Ш Yе└┤┤А>0) ■ Г  PERSONAL REFERENCE FORMsybilcarla■ рЕЯЄ∙OhлС+'│┘0АРXШд┤└╠▄ ь°   ,8@HPфERSsybilALybiybiNormalLcarlaL4rlMicrosoft Word 8.0F@Lя┐@║ШСэy┴@ DJ╤П┴Ш Sample Personal Reference Form■ ╒═╒Ь.УЧ+,∙оD╒═╒Ь.УЧ+,∙о\ hpФЬдм ┤╝─╠ ╘ °фNational CASA AssociationE) 1 PERSONAL REFERENCE FORM TitleШ 6> _PID_GUIDфAN{C3E11B84-E5E0-11D5-8706-00104B388F42} ■   ■    ■                                   *+,-./0■   ¤   3■   ■   6■                                                                                                                                                                                                                                                                                                       Root Entry         └F$( Єy┴А1╚пЯ┴5@Data             1Table        WordDocument    % SummaryInformation(            ░DocumentSummaryInformation8        )CompObj    jObjectPool            ░SО]╤П┴░SО]╤П┴■   ■                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               ■       └FMicrosoft Word Document MSWordDocWord.Document.8Ї9▓q■ рЕЯЄ∙OhлС+'│┘0АРXШд┤└╠▄ ь°   ,8@HPфERSsybilALybiybiNormalLcarlaL4rlMicrosoft Word 8.0F@Lя┐@║ШСэy┴@ DJ╤П┴Ш Sample Personal Reference Form