Next Gen | NYSUM 2026 | Pastoral Reference

Pastoral Reference Form

For ALL Adult Leaders (NYSUM 2026)
This Pastoral Reference Form is to be completed by the pastor of the church sending youth to the Youth Missions Trip to NYC being held at NYSUM (March 29–April 1, 2026).

Groups must have 2 adult leaders who are not related and not from the same household in order to participate.

Registration must be completed by a group leader; students may not register individually.

This reference is required for all youth pastors and adult youth leaders your church will be sending on the trip. Because pastors know their leaders’ character, conduct, and readiness for ministry, your insight is essential in helping us ensure a safe and healthy environment for every student attending.

Your honest assessment helps us confirm that each adult is prepared to serve, lead, and care well for the youth entrusted to them.
Your Full Name*

First NameLast Name
Date (mm/dd/yyyy)
E-mail*
example@example.com
Youth Pastor or Leader's Full Name*

First NameLast Name
Youth Pastor or Leader's Title and/or Responsibilities
How long have you known his leader?*
An Estimate is Fine
Your Phone Number*

Area CodePhone Number
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please complete these 12 questions about your Youth Pastor or Leader:
1. Does this individual demonstrate consistent spiritual maturity and a growing relationship with Christ?*

YesNo
2. Does this person show Christlike character and integrity in their daily conduct?*

YesNo
3. Is this individual consistently responsible, dependable, and reliable in fulfilling their commitments?*

YesNo
4. Does this individual handle stress, conflict, and correction in a healthy and stable manner?*

YesNo
5. To your knowledge, has this individual ever demonstrated behavior that would raise concern when working with youth or minors?*

YesNo
6. Is this person teachable and willing to follow leadership and instructions?*

YesNo
7. Does this individual work well with others and contribute positively to a team environment?*

YesNo
8. Do you recommend this individual to serve as a youth leader on this trip?*

YesNo
9. Spiritual, Emotional, and Character Assessment: Please describe this individual’s spiritual maturity, emotional maturity, and overall character. You may include observations relating to their integrity, how they handle correction or stress, and any strengths or concerns you feel are relevant.*
10. Leadership, Teachability, Safety, and Teamwork: Please share anything that would help us understand how this individual functions as a leader. This may include their ability to work with youth, their teamwork with other adults, their willingness to follow instructions, their dependability, and any insights related to the safety and well-being of minors.*
11. INTEGRITY*

Without reproach; of highest integrityMostly integrity-filledLacks principleQuestionable
12. ADDITIONAL REMARKS
Questions or Concerns? Contact:
Rev. John Chappell | Next Gen Director | Elim Fellowship
Email: jchappell@elimfellowship.org
Cell: (757) 752-1536
Thank you for your time and help! To complete this form, please click 'SUBMIT'
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Pastoral Reference Form

Please complete these 12 questions about your Youth Pastor or Leader:

Thank you for your time and help! To complete this form, please click 'SUBMIT'