IMPACT Participant Reference Form

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The individual to be named below is applying to be a team member on a short-term missions journey with IMPACT. This journey will involve cultural stress, ambiguity and restrictions on freedom and privacy. As the whole team will be affected by this applicant's positive and negative behavior, please be as objective and honest as possible as you respond to the following questions. REFERENCES DUE ASAP

Email *

Applicant name *

Interpersonal Skills

Please rate the applicant on the following:

Ability to communicate *

Ability to develop relationships *

Ability to confront *

Tactfulness/ Sensitivity *

Teamwork *

Please write any additional helpful information about how you rated the applicant in this area. *

Leadership Maturity

Please rate the applicant on the following:

Drive/ Initiative *

Mental Alertness *

Please write any additional helpful information about how you rated the applicant in this area. *

Spiritual Maturity

Please rate the applicant on the following:

Consistent spiritual walk *

Knowledge of the Bible *

Dependence on prayer and the Bible *

Submission to authority *

Please write any additional helpful information about how you rated the applicant in this area. *

Emotional Maturity

Please rate the applicant on the following:

Self-image *

Self-perception *

Freedom from worry/anxiety *

Relationship with opposite sex *

Marital Harmony *

Please write any additional helpful information about how you rated the applicant in this area. *

Personal Maturity

Please rate the applicant on the following:

Self-discipline *

Conscientiousness *

Perseverance *

Common sense and judgement *

Flexibility *

Decisiveness/ Follow through *

Servant's attitude *

Please write any additional helpful information about how you rated the applicant in this area. *

To your knowledge, how does this person respond under stressful circumstances? Please explain. *

Have you ever known the applicant to demonstrate more than normal discouragement, moodiness, or withdrawal? If so, please explain. *

Does this person work best alone or with others? Please explain. *

Please summarize the applicant's strengths and weaknesses (include social, emotional, personal, leadership, spiritual and ministry areas). *

Have you any reason whatsoever to lack confidence in this applicant? If so, please explain. *

How long, how well, and in what capacity have you known the applicant? *

Are there any current circumstances (mental, emotional, physical, spiritual, etc) in this person's life that would interfere with their full participation in this short-term IMPACT experience? If yes, please explain. *

Overall recommendation *

Your name- by typing your name you certify this form was filled out honestly by you. *

Phone # *

Thank you!

A copy of your responses will be emailed to the address you provided.

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