Reference Respondent

The person who sent you this form is applying as a long-term volunteer through the United Church of Christ's Partners in Service program.

Help us determine the applicant's fitness for such service and to make decisions about placement by supplying the information requested on this form.

Feel free to contact the UCC Volunteer Ministries office with any additional comments or concerns.
Mary Schaller Blaufuss blaufusm@ucc.org


By sending you access to this form, the applicant has waived the right to inspect the contents of this reference.

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* 1. Name of applicant for whom you are completing this reference form

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* 2. Name of Reference Respondant

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* 3. Street Address (permanent address)

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* 4. City/State/Zip Code/Country

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* 5. Phone Number

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* 6. E-mail Address

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