2023 AIM/Expeditions Pastoral Reference

-Pastoral Reference-
You have been asked to complete this form for a student applying for a short-term missions trip through the Assemblies of God Ambassadors in Mission (AIM) and/or Chi Alpha Expeditions program. Your cooperation in answering the following questions will help us decide whether the applicant will fit into either program. We appreciate you taking the time to complete this form, please know your insight will be kept confidential.

Please note that reference forms cannot be completed by relatives or spouses of the trip participant. Thank you!
Applicant Name - (filled out by designated leader only)*

First NameLast Name
I have been personally acquainted with this applicant for number* years.
How well do you know the applicant?*

SlightlyCasuallyWellVery Well
How involved is the applicant in church?*

NoneSlightlyInvolvedVery involved
What special talents has he/she shown?*
What special leaderships abilities has he/she shown?*
To your knowledge has the applicant participated in the use of intoxicants, tobacco, or illegal drugs?*

YesNo
If yes, please explain:*
Do you know of any reason why the applicant wouldn't be suitable to participate on an AIM trip?*

YesNo
If yes, please explain:*
Christian Life*
Social Adaptability*
Ability to get along with others*
Leadership*
Teachableness*
Cooperation*
Motivation*
Respect towards Authority*
Emotional Stability*
Healthy*
Assemblies of God Ambassadors in Mission (AIM) and/or Chi Alpha Expeditions requires the local church to have a current background check on file in church records for all Assemblies of God Ambassadors in Mission (AIM) and/or Chi Alpha Expeditions participants who are 18 years of age or older.
Frequency of Background Checks: Current insurance standards state that it is important to set a policy and follow it. A minimum standard to follow would be to conduct a background check once as long as the volunteer is in continuous service. This means that she/he serves continuously without being off for more than 1 year and 1 day.
Background report and references are on file in church records (required for those 18 years+)*

YesNo
Recommendation*

Yes, I am personally acquainted with applicant and in my opinion declare that applicat is competent and qualified to work with minors. I have no knowledge of facts or allegations that raise any question concerning his/her suitability and trustworthiness for working with minors.No, Based on my knowledge of applicant I DO NOT recommend him/her to work with minors.
Additional Comments:
Please Complete:

The person providing reference may not be related to applicant - in that case another staff pastor or church board member may complete the form.
Person Completing Form Name*

First NameLast Name
Church Name*
Your Church position:*

Lead PastorStaff Pastor
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Office Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Email*
example@example.com
Signature (use cursor or finger)*

Clear
Date Signed
approval

ApprovedNot Approved
Should be Empty:

-Pastoral Reference-

Please Complete: