VSSM Pastoral Reference Form

Student's Name *

YOUR Name *

Date of Birth

Day Month Year

Your Phone Number

Area Code Phone Number

E-mail Address

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Gender

Male Female

Do you recommend this student?

Highly Recommend Recommend Do not recommend

Can you please explain your recommendation:

How long have you known the applicant?

In what capacity:

How well do you know him/her? Please explain:

To your knowledge, has the applicant made a personal commitment to Jesus Christ?

Yes No I'm not sure

To your knowledge, has the applicant been baptized in the Holy Spirit?

Yes No I'm not sure

To what extent is the applicant engaged in the activities of your church?

In what form of Christian service has the applicant participated regularly (Sunday School Teacher, Youth Leader, nursery Worker, etc.) ? Please explain:

What do you consider to be the applicant's strengths?

Do you know of any weaknesses of which we should be aware of?

To your knowledge, does the applicant use tobacco? If yes, please explain:

To your knowledge, does the applicant drink alcohol in excess? If yes, please explain:

To your knowledge, does the applicant use illegal drugs? If yes, please explain:

Please describe home factors which might affect the applicant's success at Vanguard School of Supernatural Ministry:

For the following questions, please rate the applicant on a scale of 1-10, with 1 being the weakest and 10 being the strongest. Please provide any additional information necessary:

The applicant's influence on his or her pears:

Response to Authority:

Reliability, dependability, responsibility:

Maturity - personal development, ability to cope with life situations:

Emotional Stability - reaction to stress, poise, mood stability:

Motivation - Genuineness and depth of commitment:

Judgement - ability to analyze a problem:

Oral expression - clarity, coherence:

Interpersonal relations - rapport, cooperation, attitudes toward supervision:

Empathy - sensitivity to the needs of others:

Work habits - stamina, conscientiousness, perseverance, resourcefulness, initiative :

Leadership - creative thought, curiosity, self-confidence:

Personal appearance - cleanliness, grooming:

Integrity - honesty, moral character:

Please add any further comments you may have which would help in our evaluation:

VSSM PASTORAL REFERENCE