2019 CITs - Pastor/Youth Leader Reference Form

Dear Pastor or Youth Leader,

You have been listed as the current pastor or youth leader of the individual mentioned, who has expressed an interest in working with children or youth as a Counselor-in-Training during the Summer Camp Ministry of Camp Dixie. The Counselor-in-Training program prepares students to serve in a future position as counselor at Camp Dixie. They attend a weekend training session, complete assignments, and, if chosen after training, will be given the opportunity to serve this summer for one or more weeks alongside an experienced camp counselor. In order for us to properly evaluate the qualifications of this applicant, we ask that you complete this survey with your honest opinions and impressions of the applicant.

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* 1. What is the name of the applicant you are recommending?

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* 2. What is your relationship to the applicant?

Pastor

Youth Leader/Pastor

Other (please specify)

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* 3. How long have you known the applicant?

Less than a year

1-3 years

3-5 years

5-10 years

10+ years

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* 4. How well do you know the applicant?

Very well- we have frequent contact

Fairly well- we have consistent contact

Casually- we have little contact

By Name- We have no contact

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* 5. How would you describe the applicants involvement at church?

Heavily Involved

Consistently Involved

Somewhat Involved

Not Involved

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* 6. Do you have any reason to believe applicant would be unreliable, dishonest, or of questionable character?

Yes (please explain)

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* 7. Do you see evidence that the applicant has learned to integrate their faith in Christ into all of life?

Yes

Not qualified to answer that question

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* 8. Does applicant show respect for authority as far as you know?

Yes

Comment:

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* 9. Do you have any concern in allowing applicant to work with children or youth?

Yes (please explain)

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* 10. Are you aware of anything in the applicants background, personality, or behavior that could in any way pose a threat to children or youth?

Yes (please explain)

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* 11. Check 3-5 words that describe the applicant

Teachable

Tolerant

Domineering

Enthusiastic

Wise

Fearful

Biblically Knowledgeable

Critical

Flexible

Dependable

Motivated

Anxious

Prejudiced

Patient

Easily Discouraged

Committed

Easily Offended

Peaceful

Stable

Understanding

Servant Hearted

Humorous

Perfectionist

Disciplined

Moody

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* 12. On a scale of 1-5 (1 being weak and 5 being strong), please rate the applicant in the following areas:

	1	2	3	4	5
Respect for Authority	Respect for Authority 1	Respect for Authority 2	Respect for Authority 3	Respect for Authority 4	Respect for Authority 5
Leadership Ability	Leadership Ability 1	Leadership Ability 2	Leadership Ability 3	Leadership Ability 4	Leadership Ability 5
Ability to Take Direction & Follow Through	Ability to Take Direction & Follow Through 1	Ability to Take Direction & Follow Through 2	Ability to Take Direction & Follow Through 3	Ability to Take Direction & Follow Through 4	Ability to Take Direction & Follow Through 5
Ability to Take Initiative Without Directions	Ability to Take Initiative Without Directions 1	Ability to Take Initiative Without Directions 2	Ability to Take Initiative Without Directions 3	Ability to Take Initiative Without Directions 4	Ability to Take Initiative Without Directions 5
Concern for Others	Concern for Others 1	Concern for Others 2	Concern for Others 3	Concern for Others 4	Concern for Others 5
Participation in Activities	Participation in Activities 1	Participation in Activities 2	Participation in Activities 3	Participation in Activities 4	Participation in Activities 5
Enthusiasm	Enthusiasm 1	Enthusiasm 2	Enthusiasm 3	Enthusiasm 4	Enthusiasm 5
Communication Skills	Communication Skills 1	Communication Skills 2	Communication Skills 3	Communication Skills 4	Communication Skills 5

Comment:

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* 13. What is YOUR name?

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* 14. In order to verify this reference, we will need to contact you upon receiving this information. Please provide an email address to which we can send a confirmation email. This reference will not be filed until we have received your email confirmation.