Joshua Center for Neurological Disorders Camp Staff Reference Form Please complete this form as requested by your friend/colleague. What is your name?* First Last What is the name of the individual you are providing reference information for?* First Last How long have you known the individual?* This individual ... has the qualifications to meet the challenges of children with disabilities. doesn't have the qualifications to meet the challenges of children with disabilities. How do you know the individual requesting you as a reference?* is a current employee is a former employee served as a volunteer is a student 1. Rate the work history of this individual.* Poor Fair Good Very Good Excellent 2. Rate how well you feel this individual is qualified to perform the camp assignment.* Poor Fair Good Very Good Excellent 3. Rate this individual’s ability to interact with children.* Poor Fair Good Very Good Excellent CAPTCHANameThis field is for validation purposes and should be left unchanged.