Pastoral Reference Form Before Beginning TO THE PASTOR COMPLETING THIS FORM: You need to be over 21 years old, cannot be a relative, and must have known the applicant for at least one year. If you are the parent and pastor of the applicant, the youth pastor, elder or a leader in the church will be accepted. Please answer the following questions carefully. General Information Name of applicant (required) First name (required) Last name (required) Email address (required) Phone number (required) How long have you known the applicant? In what capacity? How well do you know him/her? Just by name and sightCasually - have had a few contactsFairly well - have had a number of personal contactsHave had a very close pastor-young person relationship As far as you know, has s(he) been born again by faith in Jesus Christ? YesNo Comments: To what extent has the applicant engaged in the activities of your church? Very irregular in attendance; little interest in activitiesSeldom participates in activities; does regularly attendIs cooperative & usually willing to help in various activitiesEnthusiastically engages in activities of the church In what forms of Christian Service has the applicant been regularly active? (Sunday school, Choir, Children’s church, etc.) If applicant doesn’t participate, do you know why? Does s(he) come from a Christian home? A well-disciplined home? Receive encouragement at home? Is s(he) inclined to receive instruction? Yield to discipline? Does s(he) have any special talents or abilities? (Please list) Have you noted any particular weaknesses? (Please list) Have you observed anything that would be questionable about his/her moral life? If so, explain: Have you ever known the applicant to use intoxicating beverages? tobacco? drugs? If so, explain: Personality and Character Assessment Check the rating that indicates your estimate. Additional remarks for fuller explanation will be most helpful to us. Spiritual Life Vital & ContagiousRich & Growing in MaturityAverageGenuine, but not ContagiousCharacterized by Immaturity Additional Comments: Initiative Anticipates Needs: ResourcefulShows Good InitiativeAverage – Occasional InitiativeRequires Some DirectionRequires Constant Supervision Additional Comments: Cooperation Works Well With OthersWorks Well Under OthersCooperative Only Under PressureNot Cooperative Additional Comments: Judgment DiscerningGood Common SenseAveragePoor Sense of Values Additional Comments: Tactfulness Very Sensitive to OthersUsually CourteousSometimes UntactfulBlunt, OutspokenInsensitive to Others Additional Comments: Responsibility Capable of Much ResponsibilityThoroughly DependableUsually ReliableShows Some DependabilityIrresponsible, Careless Additional Comments: Industry Seeks Additional WorkGoes Beyond What Is RequiredCooperativePerforms Assigned TasksNeeds ProddingDifficult to Handle Additional Comments: Acceptance By Others Sought After By OthersWell Liked By OthersLiked By OthersJust Tolerated By OthersAvoided By Others Additional Comments: Leadership Inspiring and Successful LeaderGood LeadershipAssumes Occasional LeadershipTries, But Usually Fails at LeadershipAlways a Follower Additional Comments: Emotional Stability Exceptionally StableWell BalancedUnresponsiveHigh Strung, but ControlledExcitable-Easily Upset Additional Comments: Personal Appearance Neat AppearanceAverage AppearanceCareless in Dress Additional Comments: Your Electronic Signature Please Print Your Name Below