pastoral reference form Applicant Name * First Name Last Name Reference Name * First Name Last Name Reference Relationship to Applicant * (e.g. Youth Pastor, Pastor, Mentor, etc.) Reference Email * Reference Cell Phone Number * (###) ### #### Church Name * How long have you known the applicant? * How well do you know the applicant? * By Name Casually Fairly Well Very well Please rate the following character traits of the student: Applicant Adaptability * Excellent Above Average Average Fair Poor Applicant Servanthood * Excellent Above Average Average Fair Poor Applicant Dependability * Excellent Above Average Average Fair Poor Applicant Spiritual Life * Excellent Above Average Average Fair Poor Applicant Maturity * Excellent Above Average Average Fair Poor Applicant Response to Authority * Excellent Above Average Average Fair Poor Applicant Spiritual Influence On Peers * Excellent Above Average Average Fair Poor How often does the applicant display these characteristics: Applicant Procrastinates * Never Rarely Sometimes Often Frequently Applicant Critical * (tends towards speaking with criticism) Never Rarely Sometimes Often Frequently Applicant Irritable * Never Rarely Sometimes Often Frequently Applicant Depressed * Never Rarely Sometimes Often Frequently Applicant Argumentative * Never Rarely Sometimes Often Frequently Applicant Domineering * Never Rarely Sometimes Often Frequently Applicant Rebellious * Never Rarely Sometimes Often Frequently To your knowledge, has the applicant had a salvation experience? * Based on your knowledge, is the applicant active in his/her church? Applicant Church Involvement * Yes No Not sure How and/or where is the applicant involved in the church? Please provide details To your knowledge, is he or she involved in any ministries outside his/her church? * Yes No Not sure How and/or where is the applicant involved in ministries outside his/her church? Please provide details To your knowledge, does the student and family understand the unique format of Street Invaders in which the student will participate in mission training and an outreach mission trip that the student will be expected to serve on? * Please note that Street Invaders is a more intensive program than a typical summer camp due to the missional element. Does the student display consistent, stable, reliable, and good character? * Please provide details Do you have any reason to lack confidence in the applicant's ability to participate in the Street Invaders program? The challenge of the program includes: the ability to serve, minister, act as team player, be stretched, participate in long hours, adapt to new environments, etc. * If yes, please provide details. If no, just write "no." Have you ever had reason to question the applicant's consistency in practically living out their faith? * If yes, please provide details. If no, just write "no." To your knowledge, does the student require supports relating to their physical or mental health? * If yes, please provide details. If no, just write "no." Based on the information you have shared with us, would you recommend this student to be involved with Street Invaders this summer? * Strongly Recommend Recommend Recommend with Reservation Not Recommended We would appreciate any additional comments you might have concerning the applicant: Thank you!
