Reference Form Volunteers

This is a Character Reference Form for Volunteer Applicants.  A character reference cannot be a family member. 

Your name has been given as a personal reference.  Please complete the following information and return this form to the address above as soon as possible.


Please rate the following characteristics using a 1 to 5 rating system, with 5 being the highest.


In what capacity have you known this person?*


Why do you think this person would make a good volunteer?*


Would you like more information about MSHA Volunteer Programs?*

Clicking the send button is your electronic signature stating that the information you have submitted is correct!

Thank you for supporting MSHA's Volunteer Program!