NYSUM Pastoral Reference Form

NYSUM Pastoral Reference Form

(All information submitted is strictly confidential)
Pastor's Name

First NameLast Name
Name of Applicant you're referring

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title/Position (if not Senior Pastor) within Church
Church Name
How long have you known the applicant?
# of months & years
Please answer the following questions regarding the applicant and rate accordingly to the best of your judgement :
In your judgement, does the applicant demonstrate true conversion of heart and consecration to Jesus Christ with an evident desire to serve Him?
Industry/Performance

Other (Specify)
Responsibility

Other (Specify)
Response to Authority including Correction

Other (Specify)
Willing to serve

Other (Specify)
Cooperativeness

Other (Specify)
Team Work

Other (Specify)
Leadership

Other (Specify)
Spiritual Maturity

Other (Specify)
Devotional Life (Prayer, Bible, Faith)

Other (Specify)
Integrity & Morals

Other (Specify)
Emotional Stability

Other (Specify)
Concern for others

Other (Specify)
Influence on others

Other (Specify)
Social Skills

Other (Specify)
Personal Appearance

Other (Specify)
Please check any of the possible motivations for the applicant to join this program:

Other (Specify)
I find the applicant:

Other (Specify)
If there is any other information you feel will help us review the applicant better, or that should know in advance prior to making any decisions, please use the space below:

0/500
Signature
Should be Empty: