Greetings in the Name of Jesus Christ!

We want to thank you for taking the time to complete this confidential reference form on behalf of a Patmos: Reality Discipleship applicant. Patmos: Reality Discipleship is a discipleship program of Coast Hills Church in which participants are challenged by the Word of God for the purpose of change. It is both challenging and intense. Admission to Patmos: Reality Discipleship is based on the applicant’s emotional, spiritual, and physical willingness to participate fully in the program. We would ask that you would, therefore, be as objective as possible in your evaluation. This reference will be most valuable to us when completed as honestly as possible by someone who has known the applicant for at least one year and is not an immediate family member. If you have any questions about Patmos: Reality Discipleship, feel free to email us at or check out our website at Thank you again for your time.