Volunteer Applicant Reference Form

Each Children’s Hospital of Pittsburgh of UPMC volunteer applicant is required to submit two online reference forms as part of their initial volunteer application requirements. If you have received this link, you have been asked by a volunteer applicant to complete a reference on their behalf. Your input is very important to the application process. All information contained on this form will remain confidential.

In completing this reference form, we ask that you consider the following:
  • Be candid in your evaluation of this person in responding to the questions provided below.
  • Provide thoughtful responses to offer insights that would be helpful for the selection and potential placement of this volunteer applicant.
  • Please refrain from using single word answers.
  • Keep in mind that you are not eligible to complete this form if you are a family member or relative of the applicant.
  • In the “other comments” section, you are encouraged to add any additional information you feel would be useful and relevant.

Volunteer Applicant's First Name:  
Volunteer Applicant's Last Name:  
Volunteer Applicant's E-mail:    
Volunteer Type:  
How long have you known the applicant?  
In what capacity do you know the applicant?  
Do you feel the applicant is appropriate to interact with hospitalized children and their families?

Describe the applicant's reliability and willingness to make a committment to volunteer.  
Do you feel the applicant has any limitations? Please explain.  
Please comment on the applicant's attitude in general and other characteristics such as dependability.  
Would you have any reservations about recommending this candidate for volunteer services?

If yes, please explain.
Other Comments:

Recommender's First Name:  
Recommender's Last Name:  
Recommender's E-mail:    
Daytime Phone Number:  

Upon completion of this form, the volunteer applicant will receive an automatic email reply to the email address entered on this form. This email will notify the applicant that a reference has been submitted on his or her behalf.

Thank you for taking the time to share the above information, as these references are a valuable component of the volunteer application.