Loudoun County Homepage Adult Volunteer Reference Form
* indicate required fields

You have been requested to provide a reference for someone applying to be an adult volunteer for Loudoun County Parks, Recreation and Community Services. Please respond to each of the following categories which best describes your knowledge of the applicants ability in that area and their ability for volunteer work.

*Please state your full name

*Please input the first and last name of the applicant that you are providing a reference for.

*How do you know this volunteer? Note: A family member is not an acceptable reference source.

If you answered, "other" to the previous question, please explain how you know the applicant. (max 1000 characters)

*How long have you known this applicant?
1 - Poor2 - Between poor and good3 - Good4 - Between good and excellent5 - Excellent
How do you rate the applicant's communication skills? (Their ability to express themselves clearly and concisely)* 
How do you rate the applicant's listening skills?* 
How do you rate the applicant's people skills? (Ability to exhibit warmth, empathy and patience)* 
How do you rate the applicant's dependability and reliability?* 
How do you rate the applicant's trustworthiness?* 
How do you rate the applicant's flexibility?* 

*Do you have any reservations recommending this volunteer to work with vulnerable adults in the community? If so, please explain. (max 1000 characters)

*Please enter your email address so that we can contact you with any additional questions about the applicant.

The Loudoun County Area Agency on Aging appreciates your honest opinion and hopes that you feel free to express any concerns that you may have. If you wish to further discuss any concerns, please call the Volunteer Coordinator, Debra Bressler at 703-777-0257.

Please click the submit button below to complete this reference form.