SOMD Reference Form

IMPORTANT: The applicant has waived any right to read or obtain copies of this recommendation. The applicant has applied for admission to Youth With A Mission. Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully. Your early response will be most appreciated, as the applicant's file cannot be considered until this office has received all forms. Please feel free to make additional comments and email them to us at [email protected]. Thank you for taking time to help us in this way. We sincerely appreciate your cooperation.

Name of Applicant You're Filling Out This Reference For:*

Known Applicant For How Long?*

Please check the following, and comment when necessary.

How well do you know the applicant?*

Very Well
Well
Casually

Your relationship to the applicant is:*

The Candidate's:

Ability to Follow*

Superior
Above Average
Average
Below Average

Concern for Others*

Superior
Above Average
Average
Below Average

Decision-Making*

Superior
Above Average
Average
Below Average

Emotional Stability*

Superior
Above Average
Average
Below Average

Health*

Superior
Above Average
Average
Below Average

Initiative*

Superior
Above Average
Average
Below Average

Leadership*

Superior
Above Average
Average
Below Average

Personal Appearance*

Superior
Above Average
Average
Below Average

Social Adaptability*

Superior
Above Average
Average
Below Average

Comments:

Christian Character*

Well Balanced
Average
Unstable

Cooperativeness*

Works Well with Others
Average
Avoids Group Activities

Disposition*

Cheerful
Average
Passive

Financial Responsibility*

Honors Obligations
Average
Neglectful

Flexibility*

Open to Change
Average
Unyielding

Industry*

Hard Worker
Average
Lacks Persistence

Mental Ability*

Quick to Comprehend
Average
Slow

Punctuality*

Punctual
Average
Often Late

Reliability*

Meets Obligations
Average
Neglects Obligations

Comments:

Is the applicant active in church work? (Please give details.)*

Do they display high moral standards?*

Yes
No

Please Explain:

Are they prejudiced against any group, race, or nationality?*

Yes
No

Please Explain:*

With reference to their Christian service, do you consider the applicant to be:*

Dedicated
Average
Casual

Please Explain:

Which of the following would best describe the applicant’s Christian experience?*

Mature
Contagious
Genuine and Growing
Over-Emotional
Superficial

Please Explain:

What could YWAM do to aid the applicant’s personal development?

Please comment on the applicant’s family background (If known):

Please add any other pertinent remarks (i.e. medical, psychological, drug or alcohol abuse, criminal record, occult practices, etc.).

Is the applicant financially responsible?*

Would you recommend the applicant for acceptance into Youth With A Mission?

Yes
With Some Reservation
No

Please Explain:

Personal Information

Reference's (Your) Name:*

Title:*

Reference's (Your) Phone Number:*

Reference's (Your) Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please type your full name to certify that the information given above is accurate.*

Today's Date*

Please check the following, and comment when necessary.

The Candidate's:

Personal Information