190 Old. A. J. Highway, C-N Box 71904

Jefferson City, TN  37760

Applicant’s Name (Not the person filling out this reference!!)

Please be as objective as possible in your evaluation of the applicant.  Your reference will be most valuable to us when completed honestly and returned in a timely manner.  Serving with the Appalachian Outreach summer staff requires a genuine Christian commitment, a willingness to work hard, an ability to relate well to others, flexibility, and an interest in Christian service and spiritual growth.  You are an important link in helping us determine whether the applicant meets these criteria.

To be completed by the person filling out this reference.

Name    Phone Number

Address City State Zip

Email Address

In what capacity have you known the applicant?
    Student Minister   Church Staff   Professor/Teacher   Friend  Employee
    Other

How long have you known the applicant?  years.

How well do you know the applicant? Very well   Casual Acquaintance   Close friend     Not at all

Briefly describe the nature of your relationship with the applicant and their work ethic:  Please place a check in each box that describes the applicant.  You may check more than one box if necessary.  Leave blank if you cannot answer.

Check any traits that characterize the applicant:

Does the applicant have any habits or characteristics that his or her direct supervisor should be aware of, or cautioned about, to help ensure good team relationships and to help applicant grow in both character and ministry skills?
    Yes     No   If “yes”, please explain:
none

Do you have any hesitations or reservations about the applicant’s qualifications?
     Yes     No   If “yes”, please explain:
none

If you have any information that you prefer to share by telephone, please give us a number where you can be reach during the day. 

If you were going on a 10-week mission project, would you want this person on your team?   Yes     No

Additional Comments:

OVERALL RECOMMENDATION   Very strongly    Strongly    Somewhat    Not recommended

In lieu of a signature, please type your title and full name:

When you click on the Submit button below, your responses to this form will be automatically sent to Appalachian Outreach. The date, time, computer identification and username will be automatically transmitted to Appalachian Outreach along with all your responses.  Please review your responses for accuracy before submitting this form.

After submitting the above form, a confirmation page will display all of your responses. That page may be printed or saved on your computer for your records. If you wish, you may drag your mouse over the lines of the above form, to select the entire form. Then you should be able to use the print function of your web browser to obtain a printed copy of this form and your responses. You should choose the "selected" portion of the printout, to avoid printing this entire web page. The printed copy may be used for your records or for sending the form by mail if you prefer not to use email.