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The League for People with Disabilities, Inc.
Camping & Therapeutic Recreation
1111 East Cold Spring Lane
Baltimore, MD 21239
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Jonathon Rondeau, Director
Voice: (410) 323-0500 ext.366
Fax: (410) 323-3298
E-mail: jrondeau@leagueforpeople.org Web:
www.campgreentop.org
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Confidential Reference Form
Applicant's Name: _________________________________________________________
Position Applied for: _______________________________________________________
Home Phone: _____________________________________________________________
Work Phone: _____________________________________________________________
1. How long have you known the applicant?
2. In what relationship (Teacher, Clergyman, Employer, Neighbor, etc.)?
3. How would you rate the applicant's probable success as a staff member in a residential camp for individuals
with disabilities? Please check one:
Superior ____ Above Average ____ Average ____
Below Average ____
4. Please give a general summary of the applicant's abilities (including such characteristics as initiative, leadership
potential, understanding of children, work ethic, responsibility, maturity, judgment, etc.)
Signature: _______________________________________________________________
Date: ___________________________________________________________________
Name (Please print): _______________________________________________________
Phone: __________________________________________________________________
Position: _________________________________________________________________
Organization: _____________________________________________________________
*** Please use reverse side for any additional comments you may wish to make. ***