Reference Submission Form

Applicant Name: *

First

Middle

Last

Please provide the name of the person requesting you to provide a reference. The above applicant has applied for admission to the Discipleship Training School, at Youth with a Mission, Lusaka, Zambia (YWAM). YWAM is a Christian mission-oriented, international, interdenominational organisation. YWAM, founded in 1960, now has centres in over 500 locations on all continents. Serious consideration will be given to your comments; therefore we ask that you complete this form carefully and honestly. Thank you for your assistance.

What type of reference are you submitting? *

What is your relationship or influence on the applicant? For Pastor or Spiritual Leader, select “Mentor” For Employer/Business Associate/Teacher, select “Professional”. For Friend or any other relationship, select “Personal”.

Referee Name *

Salutation:

or Other:

Full Name: *

First

Last

Address: *

Street

City: *

City:

State: *

State:

Postcode: *

Postcode:

Country: *

Country:

Phone:

Phone (H):

Phone (B):

Mobile: *

Mobile:

Email: *

Occupation or Title (if applicable): *

Church or Business Name: *

Character Profile:

Selected Value: 1

1. Ability to follow? Below Average: 1, Average=2, Above Average=3

2. Ability to work well with others?

Selected Value: 1

2. Ability to work well with others? Below Average: 1, Average=2, Above Average=3

3. Accountability?

Selected Value: 1

3. Accountability? Below Average: 1, Average=2, Above Average=3

4. Concern for others?

Selected Value: 1

4. Concern for others? Below Average: 1, Average=2, Above Average=3

5. Emotional stability?

Selected Value: 1

5. Emotional stability? Below Average: 1, Average=2, Above Average=3

6. Financial responsibility?

Selected Value: 1

6. Financial responsibility? Below Average: 1, Average=2, Above Average=3

7. Flexibility/Open to change?

Selected Value: 1

7. Flexibility/Open to change? Below Average: 1, Average=2, Above Average=3

8. Grateful spirit?

Selected Value: 1

8. Grateful spirit? Below Average: 1, Average=2, Above Average=3

9. Initiative/Self-starter?

Selected Value: 1

9. Initiative/Self-starter? Below Average: 1, Average=2, Above Average=3

10. Industrial/Hard-worker?

Selected Value: 1

10. Industrial/Hard-worker? Below Average: 1, Average=2, Above Average=3

11. Leadership?

Selected Value: 1

11. Leadership? Below Average: 1, Average=2, Above Average=3

12. Mental ability/Quick comprehension?

Selected Value: 1

12. Mental ability/Quick comprehension? Below Average: 1, Average=2, Above Average=3

13. Personal appearance?

Selected Value: 1

13. Personal appearance? Below Average: 1, Average=2, Above Average=3

14. Positive attitude?

Selected Value: 1

14. Positive attitude? Below Average: 1, Average=2, Above Average=3

15. Reliability/Meets obligations?

Selected Value: 1

15. Reliability/Meets obligations? Below Average: 1, Average=2, Above Average=3

16. Response to authority figures?

Selected Value: 1

16. Response to authority figures? Below Average: 1, Average=2, Above Average=3

17. Response to pressure?

Selected Value: 1

17. Response to pressure? Below Average: 1, Average=2, Above Average=3

18. Servant-heart?

Selected Value: 1

18. Servant-heart? Below Average: 1, Average=2, Above Average=3

19. Spiritual growth observed?

Selected Value: 1

19. Spiritual growth observed? Below Average: 1, Average=2, Above Average=3

20. Teachable spirit?

Selected Value: 1

20. Teachable spirit? Below Average: 1, Average=2, Above Average=3

Does the applicant display high moral standards? *

No
Yes

If "No", please explain:

If “No”, please explain:

In your consideration, which of the following would best describe the applicant’s Christian experience? *

Please comment on the applicant's character… *

Strengths:

character weaknesses *

Weaknesses:

Is the applicant able to work through personal problems without affecting their work or others? *

No
Yes

Comments and remarks

Comments and relevant remarks:

What kind of work would you recommend this applicant for?

Would you have the applicant on your staff? *

No
Yes

Comments

Comments:

Would you recommend the applicant for acceptance to Youth with a Mission – Lusaka? *

No
Yes, with hesitation
Yes, unreservedly

Comments

Comments:

How long have you known the applicant for? *

Years:

Months *

Months:

Do you have any other relevant comments about the applicant?

I confirm that the above is true and accurate to my knowledge of the applicant *

I Agree

Signature: *

Full name (typed out):

Date: *

Date (dd-mm-yyyy)