America Reads Literacy Mentor Reference Step 1 of 4 25% Thank you...for taking the time to complete this reference form. All prospective Nittany Lions Read Mentors are required to provide two reference letters/forms. The information you are about to provide will enable us to get a bigger picture of the candidate, their strengths and what areas they are developing. Reference Contact InformationDate* Name* First Last Are you affiliated with an agency or program?*YesNoAgency/program name*Position/title*Email* Phone* Applicant InformationName of applicant*The person you are speaking on behalf of (not your name). First Last How long have you know the applicant?*Less than 1 year1-2 years2-5 years5-10 yearsMore than 10 yearsWhat is your relationship to the applicant?*This relationship can be either present or past. Check all that apply. Employer Co-worker Professor/teacher Advisor Clergy/Lay leader Neighbor Mentor Friend Have you had the opportunity to observe the applicant interact with children?*YesNoWhat were the ages of the children?*Check all that apply. Infants (0-1) Toddlers(1-3) Preschoolers (3-5) Elementary Aged (5-11) Middle School Aged (12-15) High School Aged (15-18) Please describe the setting of these interactions and your observations.* Have you had the opportunity to observe this applicant in a work related setting?*YesNoPlease describe the work setting and your observations.* Have you had the opportunity to observe this applicant in a volunteer capacity?*YesNoPlease describe the volunteer setting and your observations.* Nittany Lions Read is not just about helping others improve reading and writing skills. The program makes placements in a variety of settings which focus on a variety of literacies. Examples: science literacy, adult literacy, environmental literacy, etc. What do you see as this person's potential to provide literacy support?* Describe this person's strengths (e.g. communication, leadership, critical thinking, ability to collaborate with others, etc.)* Describe any challenges or areas that s/he is further developing.* What would be helpful to know about the applicant that we might not glean from an interview?* If you had to describe the applicant using only three words, what would they be?* Signature*Using your mouse, please make your best attempt to provide a signature below.