You have been asked to be a reference.
Please complete the following.
Your name:
Volunteer's name:
This person has volunteered to serve as a guardian or conservator with the Kansas Guardianship Program. Please respond to the following questions to assist us in the process of screening the applicant. The information you provide will be kept confidential and not be released to the applicant or any other party without your written permission. Thank you for giving this your prompt attention.
 
1.How long have you known the applicant?
What is your relationship to the applicant (friend, co-worker, relative, etc.)?
Please rate the abilities and characteristics of the applicant with the following scale:
5 = High     1 = Low     DK = Don't Know
 
2.     KGP seeks volunteers who are compassionate, caring and willing to serve as personal advocates.
Appropriate in response to the needs of others5   4   3   2   1   DK
Interact with people of differing backgrounds and opinions5   4   3   2   1   DK
Interact with persons with mentally disabling conditions5   4   3   2   1   DK
Comments:
 
3.KGP seeks volunteers who are dependable and keep commitments.
Personal integrity and honest5   4   3   2   1   DK
Fulfill commitments in a timely manner5   4   3   2   1   DK
Independent and assertive5   4   3   2   1   DK
Self initiative5   4   3   2   1   DK
Work with limited supervision5   4   3   2   1   DK
Comments:
 
4.KGP seeks volunteers able to make wise and appropriate decisions regarding another person.
Willing to learn new information5   4   3   2   1   DK
Follow guidelines and procedures5   4   3   2   1   DK
Makes decisions with reason and logic5   4   3   2   1   DK
Maintain accurate records and documents5   4   3   2   1   DK
Comments:
 
5.KGP seeks volunteers able to make appropriate decisions regarding another person's financial affairs.
Manage finances5   4   3   2   1   DK
Pay bills in a timely manner5   4   3   2   1   DK
Maintain accurate financial records5   4   3   2   1   DK
Balance a checkbook with bank statement5   4   3   2   1   DK
Comments:
 
6.Please give us a short evaluation of the applicant's character and abilities.