• Welcome Letter
• Becoming a Dogs On Call Team
• MCV Volunteer Data Sheet
• MCV Volunteer Reference Form
• Policies & Procedures

MCV Hospitals at the VCU Medical Center

Volunteer Reference Form

Date ____________

Volunteer Name _____________________________ phone ___________

Address _____________________________________________________

Vol. Placement _______________________________________________

Reference Name ______________________________phone __________

(please do not include family members)

Question 1. How long have you known applicant? _____________

Question 2. What is/was applicant’s relationship to you? _____________________________________

Question 3. What are the applicant’s strengths?

____________________________________________________________________________________

____________________________________________________________________________________

Question 4. What are the applicant's weaknesses?

____________________________________________________________________________________

____________________________________________________________________________________

Question 5. (optional) Is there any particular story you can relate about the applicant that would

indicate how this person would do as a volunteer in a large hospital?

______________________________________________________________________________________

If there is any other information you have that relates to the applicant’s abilities to be a volunteer, please feel free to write on the back of this page. We thank you for your time in completing this reference form.

If you feel more comfortable talking to us by phone, the Volunteer Services number is ---(804) 828-0922.

Please return this form to: VCUHS Volunteer Services

P.O. Box 980256

Richmond, VA 23298-0256