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: