Personal Reference

Your personal reference may not be an immediate family member and it also may not be the same person who fills out any other reference form(s) for you.

To be completed by adopter/foster applicant:

Name: _____________________________________________________

Address: ___________________________________________________

Phone:  ____________________________________________________

To be completed by reference:

Name: _____________________________________________________

Address: ___________________________________________________

Phone:  ____________________________________________________

How long have you know the applicant? ____________________________

Describe your impression of the care and condition of the animals the applicant currently owns:


Do you think the applicant would make a good foster or adoptive home for an animal from Animal Protection Coalition, Inc.?

Why or why not?


Signature 

Date

Thank you for taking the time to complete this form!

Return to:

Animal Protection Coalition, Inc.
916 S Prairie Ave
Frankfort, IN 46041
PH (765) 659-5209
Fax (206) 338-5604