Pastor Reference Form 
Instructions:

AttaKid! is a Christ-Centered mentor program involved with children and families “at risk.” The below named individual is being considered for involvement with an at-risk child in a mentoring relationship. Due to the difficult nature of working with at-risk children, we need a candid recommendation from you as their pastor. To help us determine whether this person is best suited for this type of volunteer work, we would appreciate you taking the time to answer the questions on this form as fully and specifically as you can. Please be assured that this will be kept in confidence. Thank you.
* Indicates required question
Email *
Your Name *
Your answer
Church Name *
Your answer
Phone Number *
Your answer
Email *
Your answer
Name of Mentor Applicant *
Your answer
How long have you known the applicant? *
Your answer
In what capacity?
*
Your answer
Does the applicant have a good home relationship?
*
Your answer
Does he/she work well with others?
*
Your answer
Please comment on his/her level of commitment.
 *
Your answer
Does he/she have a tendency to over-commit himself/herself?
*
Your answer
How would you rate him/her according to the following: Personal Habits
 *
Poor
Excellent
How would you rate him/her according to the following: Character
 *
Poor
Excellent
How would you rate him/her according to the following: Compassion for those in need
 *
Poor
Excellent
How would you rate him/her according to the following: Morals
 *
Poor
Excellent
How would you rate him/her according to the following: Responsibility to complete commitments
 *
Poor
Excellent
How would you rate him/her according to the following: Emotional stability
 *
Poor
Excellent
How would you rate him/her according to the following: Christian maturity    
 *
Poor
Excellent
How would you rate him/her according to the following: Receives constructive criticism  
 *
Poor
Excellent
How would you rate him/her according to the following: Personal Health
 *
Poor
Excellent
If you were in our position, would you, without hesitation, consider this person to be a volunteer in this capacity?
 *
Your answer
Is there any reason why you would not recommend this applicant for working with a child?
If yes, please explain.
*
Your answer
To your knowledge, has the applicant ever been arrested, yes or no? Please comment.
 *
Your answer
To your knowledge, has the applicant ever been accused or convicted of child abuse, yes or no? Please comment.
 *
Your answer
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