TRIP  APPLICATION, part 2

Pastor’s Reference

www.ilovejamaica.org Missions Trip

APPLICANT:  Please fill-in your name, phone and date of birth; then give the Pastor’s Reference to your senior pastor or youth pastor. Please print legibly.

Applicant’s Name________________________________________________________

Applicant’s Phone(______)______________________

Applicant’s Date of Birth_______/_______/________

THE FOLLOWING PORTIONS ARE TO BE COMPLETED BY YOUR PASTOR OR YOUTH PASTOR.

PASTOR: Please complete the following recommendation and mail it to Mark Muirhead Ministries, Inc. at the address on the bottom of page 2 of this form. 
DO NOT RETURN THIS PASTOR’S REFERENCE APPLICATION FORM TO THE APPLICANT.

Please print legibly.

Pastors Name____________________________________________________________

Title___________________________________________________________________

Church Name____________________________________________________________

Church Address__________________________________________________________

City_____________________________________State________Zip________________

Church Phone(_____)______________________Home Phone(____)________________

Cell Phone(_____)________________________Email___________________________

Please read the following before filling out this recommendation.

Serious consideration will be given to your evaluation of the applicant’s character and fitness for short-term missions.  Your responses will be held in strict confidence. 

How long have you known the applicant?______________________________________

How well do you know the applicant?  (circle one)

             By Face/Name         Casually              Fairly Well            Very Well

Which of the following best describes the applicant?

Skills:  Use numerals 1 being lowest to 5 being highest.

_______Adaptability                                   

_______Servant Life                               

_______Dependability                                  

_______Spiritual Life                                   

_______Maturity                                         

_______Response to Authority                    

_______Spiritual Influence on Others         

_______Leadership Ability                              

Pastor’s Reference, part 2

Page 2

Character:                Often             Sometimes        Rarely      Never     Unknown

Procrastinates                      5                           5                        5                    5                5

Critical                                 5                              5                           5                     5               5

Irritable                                5                           5                           5                     5               5

Inclined to crushes               5                               5                           5                     5               5

Depressed                            5                              5                           5                     5               5

Argumentative                     5                              5                          5                     5              5

Domineering                        5                              5                           5                     5              5

Rebellious                            5                              5                           5                     5              5

5Yes    5No     Is the applicant active in his/her church?

5Yes    5No     To your knowledge, has the applicant had a salvation experience?    

5Yes    5No     Are you aware of any mental or emotional illness?                       

5Yes    5No     To your knowledge, has the applicant ever used tobacco, alcohol, or 

                             illegal drugs?

5Yes    5No     If yes, within the past year? 

5Yes    5No     Have you ever had reason to question the applicant’s morality? 

5Yes    5No     Do you have any reason to lack confidence in the applicant?   

Based on the above information the applicant is:

5Strongly Recommended    

5Recommended    

5Recommended with Reservation

5Not Recommended

If the applicant was Recommended with Reservation or Not Recommended, please explain: _________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature_______________________________________________________________

Position__________________________________Date______/_______/________

Mark Muirhead Ministries, Inc. / P.O. Box 2001 / Pinehurst, NC  28370-2001

PH:  1-910-215-7777 / EM:  mark@aroundtheworldradio.org