CYIA Reference Form Step 1 of 2 50% CHILD EVANGELISM FELLOWSHIP® REFERENCEDear Applicant, This page is your reference form. Please direct your references to this online form. We will need two references on you. Church Leader Name:(Required) First Last Applicant's Full Name:(Required) First Middle Last The applicant has applied to Child Evangelism Fellowship and has listed you as a reference. A personal recommendation provides insight into a person that would be very helpful in determining his/her ability to perform responsibilities which include, but are not limited to, the following: Sharing the Gospel message and counseling for salvation and Christian growth; teaching a Bible verse; teaching a Bible Lesson; presenting missions. With these specific responsibilities in mind, please be candid and objective as you complete this form. Applicant's Chapter Name(Required) West Central Chapter SHOES Chapter Ohio State Greater Cleveland Chapter Akron Chapter Greater Canton Chapter MARCK Chapter Greater Columbus Chapter Miami Valley Chapter South Central Chapter Cincinnati Chapter How long have you known the applicant?(Required) In what relationship?(Required) How well do you know the applicant? (choose one)(Required) Casually Well Very Well Is there any reason(s) known to you why the applicant should not/could not work with children?(Required) Yes No What are the applicant's strong points?(Required)What are the applicant's weaknesses or limitations?(Required)What is the applicant's general outlook on life?(Required) Pessimistic Optimistic Unknown Has the applicant been active in the church?(Required) If so, in what capacities?(Required)In what aspect(s) of ministry have you personally observed this applicant?(Required)Does the applicant work well with others?(Required) Yes No If no, please comment: Are you aware of any unbiblical sexual tendency in the applicant?(Required) Yes No If yes, please comment: How do you rate the applicant's leadership ability?(Required) Fair Good Very Good Excellent What is the applicant's work ethic?(Required) Undependable Dependable How would you rate the applicant's standard for Christian living?(Required) Poor Fair Good Very Good Excellent Comments: Has the applicant any special talents or abilities?(Required)How do you rate this applicant's potential for children's ministry? Please give comments regarding your position.(Required) Average Superior Comments:(Required)Would you recommend that we accept this applicant?(Required) Yes No Questionable Character Trait Evaluation: Social MaturityAbility to Communicate:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Ability to develop relationships:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Attitude in confrontation:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Tactfulness/Sensitivity(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Leadership Maturity:Drive/Initiative:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Ability to quickly learn new materials:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Conflict Resolution:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Ability to handle stress:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Ability to make split-second decisions:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Ability to work independently:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Spiritual Maturity:Consistent spiritual walk:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Knowledge of the Bible:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Sense of call or mission:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Submission to authority:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Emotional Maturity:Self-image:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Freedom from worry anxiety:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Relationship with opposite sex:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Marital harmony (if applicable) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Personal Maturity:Self-discipline:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Conscientiousness:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Perseverance:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Common sense and judgment:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Flexibility:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Decisiveness/follow through:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Servant's Attitude:(Required) Not Known Poor Below Avg. Avg. Above Avg. Excellent Comments: Applicant's Name:(Required) First Last Your Name:(Required) First Last Position or Occupation:(Required) Telephone #:(Required)Email:(Required) I agree that this signature will be an electronic representation of my signature for all purposes when I use them on documents, including legally binding contracts - just the same as a wet ink signature on paper.(Required) First Last Date:(Required) MM slash DD slash YYYY