Phos House Confidential Reference Form

TO THE PERSON PROVIDING THE REFERENCE: The below-named applicant has applied to be a resident of the YWAM Phos House.

The Phos House is a ministry of Youth With A Mission (YWAM) Madison,WI.YWAM is an international movement of Christians working to help make a difference in a needy world. Founded in 1960, it is now one of the largest international, interdenominational ministries, with nearly 18,000 full time staff working in over 1,000 locations in 149 nations. YWAM Madison was founded in 1986 with the purpose of reaching the world through today’s university students. Our two-fold vision is to see students trained and equipped for world missions and to see the growing international population on U.S. university campuses reached and discipled for Christ.

The Phos House is not just a place to live, the Phos House seeks to provide a Christian community environment for students pursuing course work at the University of Wisconsin and other local colleges.

We would greatly appreciate your careful and thoughtful consideration to the questions asked on the attached form. All evaluation forms will be kept in strict confidence and will not be shown to the applicant. Your early response will be most appreciated as the applicant’s file cannot be considered until all forms have been received by this office.

References can not be accepted directly from the applicant. If you have any questions, our email is phos@ywammadison.org. Thank you for taking the time to help us in this way. We sincerely appreciate your cooperation.

Name of applicant*

First NameLast Name

Your name*

First NameLast Name

E-mail*

Phone*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Length of time of your acquaintance with the applicant (in months or years)*

What is your relationship to him/her?*

Is the applicant financially responsible?*

YesNoI haven't been able to observe their financial responsibility

What strengths will this applicant bring to the community? (Strengths of character, personality, talent, etc)*

Evaluation of the applicant's emotional & spiritual maturity.

Please check, for each category, as many as apply.

Christian Experience:*

Teamwork:*

Works well with othersAverageCauses friction/avoids teamwork

Willingness to serve:*

Eager to serveAverage/WillingReluctantMotives are confused

Emotional Resilience:*

If other, please describe

Leadership:*

SuperiorAbove averageAverageMore of a follower

Please comment on the applicant's passion for missions, concern for others, or desire to reach out.*

Have you ever noticed any of the following tendencies in your experience with the applicant?

Please check any descriptions which pertain to the applicant in any way and elaborate below. If none apply please check, none apply.

Please elaborate, if any above are checked.

Has the applicant proven to be unreliable, dishonest, or of questionable character?*

yesno

As far as you know, has the applicant ever been arrested for any offense?*

yesno

To your knowledge, has the applicant ever abused drugs, alcohol, or been involved in the occult?*

yesno

If you answered yes to any of the above 3 questions, please explain here.

I, the undersigned, commit that I answered each question thoroughly and to the best of my knowledge.

Electronic Signature*

Today's Date*

MonthDayYear