Applicant's Name Home Phone

Country of Choice

Pastor's Name Title

Church Name Church Phone

Church Address

Pastor's Email

Length of time you have known applicant How well do you know applicant? Casually Fairly Well Very Well

Please Rank applicant in the following areas, using E=Excellent. AA=above average, A=average, P=poor

Excellent Above Average Average Poor Dependability Excellent Above Average Average Poor Maturity Excellent Above Average Average Poor Leadership

Excellent Above Average Average Poor Respect for authority Excellent Above Average Average Poor Spiritual Life

Excellent Above Average Average Poor Teachability Excellent Above Average Average Poor Work Ethic Excellent Above Average Average Poor Servanthood

Please rank the applicant in the following areas, using often, sometimes, rarely, never

Often Sometimes Rarely Never Procrastinates Often Sometimes Rarely Never Argues Often Sometimes Rarely Never Is irritable

Often Sometimes Rarely Never Is depressed Often Sometimes Rarely Never Is dishonest Often Sometimes Rarely Never Fails to follow through

Is applicant active in your church? Yes No

If yes, what areas of ministry?

To your knowledge, has applicant had a salvation experience? Yes No

Are you aware of any issues in applicant's life that would disqualify him/her as a summer missionary? Yes No

If yes, please explain in space below.

To your knowledge, does applicant use tobacco, alcohol or illegal substances, or has used then in the past? Yes No

Do you have any reason to doubt that applicant is of high moral character? Yes No

If yes, please explain in space below.

Do you have confidence in applicant's abilities as a student missionary? Yes No

If no, please explain in space below.

If applicable, do you feel applicant is qualified to serve in a leadership position? Yes No

If no, please explain in space below.

RECOMMENDATION

Based upon my knowledge, the above named applicant is: Highly recommended Recommended with reservations Not recommended for missions

Is applicant is over 18 years old and is applying for leadership, I would: Highly recommended Recommended with reservations Not recommended for missions

By typing your name you are signifying that all answers are given to the best of your knowledge.

Please click the submit button only once.