Personal Reference

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You were recommended as a personal reference as part of an application to our guide dog mobility training program at Guide Dogs of America. To help in our evaluation, we are seeking information about this applicant’s independence in daily activities and travel skills. Your thoughtful responses will be treated in a confidential manner. If you wish to contact us by telephone, please call (818) 833-6428.
You were recommended as a personal reference as part of an application to our guide dog mobility training program at Guide Dogs of America. To help in our evaluation, we are seeking information about this applicant’s independence in daily activities and travel skills. Your thoughtful responses will be treated in a confidential manner. If you wish to contact us by telephone, please call (818) 833-6428.
Applicant Information
Applicant Name
Applicant's First Name Applicant's Last Name
Reference Information
Reference Name
Reference First Name Reference Last Name
Email
Your Email Address (you will receive an email confirmation upon submission)
Reference Address
Reference Street Address Reference Address Line 2 Reference City Reference State / Province Reference ZIP / Postal Code Reference Country
Personal
How long have you know the applicant?*
What is the nature of your relationship (i.e. friend, neighbor)?*
Do you feel the applicant has adjusted to being blind?*
Do you feel applicant is able to handle stress in a positive manner?*
Do you feel the applicant makes sound judgments?*
Does the applicant participate well in social gatherings?*
Is the applicant able to communicate effectively with others?*
Does the applicant keep the home maintained in a neat and orderly fashion?*
Does the applicant get out on a daily basis?*
Does the applicant have pets currently or in the past?*
Does the applicant care for pets appropriately?*
Do you know if the applicant has a guide dogs currently or had one in the past?*
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