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Impact Missions Team Reference Form

Each team member is required to have this form filled out if
this is their first short-term mission experience with Impact
Ministries or if otherwise requested by Impact Ministries.

This Reference Form is to be filled out by your Pastor, Church Elder,
Christian School Teacher, Youth Leader, or Church Small group leader.

Information you provide may be shared with Impact Ministries Staff or Team Leaders.

Your Contact Information

Title

First Name *

Last Name *

Occupation *

Address *

City *

State *

Zip Code *

Phone *

Email *

Recommendation Information

Name of Applicant *

Address of Applicant

Team Name-If Known

Date of Departure if known

INSTRUCTIONS: The applicant named above is wishing to be involved in short-term missions. You will recognize the need for great care in selecting women and men for Christian Ministry. Serious consideration will be given to your comments; therefore, we ask that you complete this form carefully and follow the prompts to submit it directly to the Impact Ministries US office online. Your comments will be held in confidence.

How long have you known the applicant?

What is your relationship to the applicant?

How well do you know the applicant?

To the best of your knowledge, has the applicant made a meaningful commitment to Jesus Christ?

Please check the terms that best describe the applicant’s attitude toward the church and its activities?

Warmhearted
Contemptuous
Respectful
Critical
Sympathetic
Enthusiastic
Passive
Loving

Please indicate what you feel are the applicant’s strengths

Please indicate what you feel are the applicant’s weaknesses

The applicant’s influence on his/her peers is

Please comment

Please comment on the family and social background of the applicant

From what you have observed, how do you rate the applicant in the following areas?

Christian Commitment

Social Adaptability

Cooperativeness

Integrity and Honesty

Responsibility/Reliability

Mental Ability

Physical Health

Flexibility

Initiative

Emotional Stability

Leadership

Please share with us any additional information about the applicant

By typing my name in the space below I declare that the contents of this confidential recommendation form are correct to the best of my knowledge. *

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Your Contact Information

Recommendation Information