Reference Form for Safe Place

Reference Request Form

Name of Volunteer *
Name of Volunteer
He/She has listed you as a personal reference, and we would appreciate your response to this questionnaire. Please be assured that the responses you make here will be held in strict confidence. We would appreciate your response to this questionnaire. Non-confidential references are available for the volunteer's review. The contents of confidential references are not to be divulged to the volunteer. If the volunteer does not sign the waiver of this form, SSBC cannot legally deny the volunteer access to the contents of this reference. Waiver of Rights of Access to Confidential Reference Letter: I voluntarily waive my right of access to this reference letter under the Family Education and Privacy Act of 1974 Public Law 93-380. (If no waiver is signed, this law permits the volunteer to inspect this reference.)