New Mexico > Local District Court > 11th Judicial District > San Juan County > Court Appointed Special Advocates
Volunteer Reference Request - New Mexico
| Volunteer Reference Request Form. This is a New Mexico form and can be used in Court Appointed Special Advocates San Juan County 11th Judicial District Local District Court . |
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a SAN JUAN COUNTY CASA PROGRAM VOLUNTEER REFERENCE REQUEST Re: _______________ Date: ______________ Dear _________________, The above referenced applicant has applied as a volunteer to our program and has given you as a reference. CASA volunteers provide information on children who are abused and neglected, making recommendations to the Court as to a childs best interest. This reference form will be used to assess the applicants ability to carry out the role of a Court Appointed Special Advocate. Selected applicants will receive a minimum of 20 hours of training and ongoing program supervision. Your information will enable us to assess the applicants ability to serve as a CASA Volunteer. Please use the enclosed envelope to return this Questionnaire. Thank you. (ALL INFORMATION RECEIVED WILL BE HELD CONFIDENTIAL IN EVERY RESPECT) 1. In what capacity have you known the applicant? ________________________ For how long? ________________ 2. How well do you know the applicant? Very well ___Well ___ Average ____ Good ___ Extreme Conflict ____ Doesnt Apply_____ 3. Applicants relationship to own children, if applicable? Good____ Average ___ Mild Conflict____ Extreme Conflict____ Doesnt Apply____ 4. Applicants relationship to youth in general. (Check as many as are applicable) Understanding____ Impatient____ Patient____ Well Liked____ Friendly____ Distant_____ Stern_____ 5. Applicants relationship with people in general. (Check as many as are applicable) Warm____ Shallow____ Sincere____ Cool____ Loyal____ Shy____ 6. How would you describe the applicants friendships? (Check as many as are applicable) Many friends constantly changing____Few friends constantly changing____ Many friends loyal_____ Few friends loyal_____ Average_____ No friends____ 7. How would you rate applicants health? Average____ Good____ Fair___Poor___ 8. Check as many of the following as describe the applicant. Domineering____ Cooperative____ Leader____ Follower____ Confident____ Happy____ Unhappy____ Friendly____ Considerate____ Stubborn____ Moody____ Assertive____ Reserved____ Lazy____ Nervous___ Well-adjusted _____ <<<<<<<<<********>>>>>>>>>>>>> 29. To what extent is this applicant aware of his/her shortcomings? Feels she/he has none_____ Strives to overcome them_____ Ignores them___ __ Accepts them_____ Unknown____ 10. Check those of the following that describe the applicants temperament? Stable____ upset_____ Impatient_____ Patient_____ Hot yilsEa -tempered_____ 11. Do you consider this applicant emotionally stable? Yes____ Usually____ If not, why not? ______________________________ 12. Describe the applicants ability to be flexible? Excellent____ Good____ Average____ Fair____ Poor____ 13. How does the applicant assume responsibility? Excellent____ Good____ Av erage____ Fair____ Poor____ 14. How well does applicant finish projects or activities begun? Very well__ __ Well____ Average____ Fair____ Poor____ 15. How would you rate the applicants ability to handle confidential inform ation? Good______ntellcexE _Fair____ Poor____ Cannot maintain confidentiality___ 16. How would you rate the applicants ability to be objective, not judging others behavior or lifestyles? Very accepting of others____ Somewhat bothered by lifestyles different t han own____ Critical of others who live and act differently_____ 17. Is this applicant critical or somewhat bothered by different ethnic back grounds? No____ Yes ____ If yes, explain ___________________________________ 18. In your opinion, has the applicant ever had a drug or alcohol problem? No____ Yes____ If yes, explain ____________________________________________________ 19. Has the applicant ever had his/her drivers license revoked or suspended ? No_____ Not to my knowledge______ Yes _____ If yes, explain______________________________ ______ 20. Has this applicant ever been accused, arrested, or convicted of a crime? No_____ Not to my knowledge_______ Yes _____ If yes, explain____________________ __________ 21. In a few words, please summarize what your overall reaction or feelings are towards this applicant. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 22. Would you be comfortable having the applicant as an Advocate for a member of your family? Yes_____ No_______ If no, why not?_______________________ SIGNATURE: ___________________________________ DATE: ________________
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