Maine 4-H STEM Ambassador Reference Form

Phone

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Adults in volunteer positions with Cooperative Extension help youth have fun while they learn new skills, increase their abilities to work together, learn to manage their own activities, and develop into productive adults.

Cooperative Extension seeks your assistance in selecting the best qualified people to serve in volunteer roles. We will appreciate your prompt completion of this reference form. All comments will be treated in a confidential manner.

Your Contact Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Please list the best telephone number to reach you at.

Email*

Please fill in your email address.

Enter Email Confirm Email

Applicant Information

Applicant's Name*

First Last

How long and in what capacity of position have you known the applicant?*

Rating of Applicant's Qualities

Please rate the applicant on a scale of 1-10 for the following qualities.

1 is the lowest rank while 10 is the highest.

Understanding of Children*

Communication*

Ability to Organize*

Respect for Others*

Ability to Complete a Task*

Dependability*

Sense of Humor*

Sense of Fairness*

Enthusiam*

Flexibility*

Patience*

Initiative*

Resourcefullness*

Please share your impression and knowledge of the applicant’s qualifications for the position by using specific examples, if possible.

How well does the applicant interact with youth?*

How would you rate the applicant’s ability to work in a volunteer role with youth? With adults?*

What additional skills, abilities, and attributes does the applicant have that would be helpful in this position?*

Does the applicant have any experience working with people who are developmentally disabled, from different ethnic backgrounds, or from varied socio-economic backgrounds? If so, please describe.*

How would you describe the applicant’s general approach to new situations?*

Would you be willing to place your son or daughter, or any other child for whom you are responsible, under her/his leadership?*

Do you know any reason why this person should NOT be a 4-H volunteer?*

If yes, please explain:

Electronic Signature*

I agree that my responses on this reference form are true and have been completed to the best of my ability.

Maine 4-H STEM Ambassadors Reference Form

Your Contact Information

Applicant Information