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.

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

* 2. What is your relationship to the applicant?

* 3. How long have you known the applicant?

* 4. How well do you know the applicant?

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

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

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

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

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

* 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?

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

* 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
Leadership Ability
Ability to Take Direction & Follow Through
Ability to Take Initiative Without Directions
Concern for Others
Participation in Activities
Communication Skills

* 13. What is YOUR name?

* 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.