Counselor Reference Form

MIDSOUTH CAMP COUNSELOR REFERENCE FORM

Personal, Non-Family Member

Please assist us in selecting our Midsouth Camp staff sponsored by the Midsouth Conference of the Evangelical Covenant Church. By completing and returning this form, you will aid the application process and provide needed information to select the most qualified staff. All references for counselors will remain confidential. Please contact Dale "Munk" Lusk at dale.lusk@covchurch.org if you have any questions.

Applicant Name*

First NameLast Name

How has the applicant been involved in your church/organization/activity during the past six months?*

What type of example for Jesus Christ would you consider the applicant to be?*

OutstandingExcellentGoodBelow average

If you indicated below average, what concerns do you have?

3. What are three of the applicant's strengths for camp work?*

How well will the applicant be able to follow the guidelines of the director and provide fair discipline to the campers?*

Very wellAverageBelow average

If you have concerns about the applicant following guidelines or giving fair discipline, please comment:

What reasons would there be for you to hesitate this applicant serving at camp?*

Your name*

Your Phone Number*

Please enter a valid phone number in case we have questions about your reference.

Your signature*