Jr. Counselor / CIT Reference Form
Please give careful consideration to the evaluations below.
This applicant has given your name as a reference that has knowledge of his/her life experiences, spiritual maturity and personality characteristics. The applicant may be working with children in a prolonged setting under physically and emotionally stressful conditions. In checking items listed below, please remember that it would be truly an exceptional person who ranks high in all categories.
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Applicant's Name *
Under each general heading, check the phrase that most accurately describes the applicant’s HABITUAL behavior with regard to that specific trait.
1. How well is the applicant able to direct and influence others along definite lines of action? *
2. How does the applicant work with peers and adults for the good of the group? *
3. How does this applicant react to suggestions or criticism by others? *
4. How responsible is the applicant? Able to completely get things done on their own? *
5. How well does applicant put his/her principles and convictions into action? *
6. How well does this person apply energy and persistence in following through with a task? *
7. How well does applicant control emotions? *
Please state briefly instances in which you have observed the applicant’s behavior as it applies to any of these items. If you have no knowledge, please indicate that rather than leaving item blank.
Would you be willing to have your children under the applicant’s supervision for a period of 24 hours or more in a camp setting? If not - why? *
Maturity of judgment: How well does the applicant react in situations of stress, i.e. making  decisions? *
Dependability - Can this applicant be relied upon? *
Does the applicant weaken in absence of authority? *
How long have you known the applicant? *
In what capacity have you observed this applicant? *
To what extent have you seen the applicant in a leadership role? *
To your knowledge, does the applicant use drugs or alcohol? *
Is the applicant prone to child or sexual abuse? *
To your knowledge, has the applicant accepted Jesus Christ as their savior and lived a life that emulates that commitment? Please explain. *
Would you, without reservation, recommend this applicant to serve in a Christian camping program with responsibilities that involves serving as a role model who emulates Jesus Christ? *
I have reviewed this reference form to the best of my knowledge; it is an accurate reflection of the applicant as observed by my interaction in his/her life. *
Please type name (first and last).
Relationship to Applicant: *
Daytime Telephone Number: *
Email: *
Thank you very much for your time!
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