Applicant's Information

Name:

Address:

Tel:

Email:

Reference Giver's Information:

Name:

Address:

Tel:

Email:

Relation to Applicant:

Position

1.How long have you known the candidate, and in what capacity?

2. How would you describe the candidate in the following areas according to your experience of him/her? (Please be as specific as possible, use examples)

a. in his/her potential for pastoral effectiveness?

b. in his/her personal commitment to learning?

c. in his/her maturity of faith and depth of spiritual development?

3. In your experience, how does this person respond to others who are experiencing times of difficulty or challenge?

4. Please evaluate the candidate on (ranging from 4 to 1, where 4 is Very strong, 3: Strong, 2: Average, 1: Needs Work; Comments: What strengths does she/he need to develop in this area?)

Intellectual ability/ General knowledge: 1 2 3 4

Common Sense 1 2 3 4

Job perseverance 1 2 3 4

Emotional Intelligence 1 2 3 4

Ability to listen 1 2 3 4

Ability to problem solve under stress 1 2 3 4

Ability to handle conflict and stress 1 2 3 4

5. Comment on the applicant’s demonstrated motivation, attitude, and readiness for an intensive experiential learning program.

6.What advice would you give this person at this point in his/her education/career that you feel would be most helpful or needed?

7.If you were hospitalized or in a personal crisis, how would you feel about a pastoral visit from this applicant?

8. This is a multi-faith program in which the applicant will learn together with students and serve patients from a variety of faith traditions: How would you describe the applicant’s knowledge and respect for other faiths and traditions as well as his/her sensitivity to cultural diversity?

9. What else should we know about this person that will help us understand and work with him/her better to be most helpful?

Digital Signature Date