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!