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Student Reference Form
Thank you in advance for your time and assistance invested in completing this form! Questions may be directed to stm@college-church or (630) 668-0878, ext. 191.
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* Indicates required question
Email
*
Your email
Student name
*
Your answer
Reference name
*
Your answer
Reference phone number
*
Your answer
How long have you known this student?
*
Your answer
How do you know this student?
*
High school pastor
HYACKs small group leader
Other
If other, please specify.
Your answer
Are you related to this student? If so, please discontinue this questionnaire. Thank you for your time.
*
Yes
No
Commitment level and involvement in HYACK small group and large group activities
*
Your answer
Ability to work as a member of a team / servant attitude
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Your answer
Initiative and leadership skills
*
Your answer
Communication skills / ability to engage others in conversations
*
Your answer
Ability to deal with stressful situations and conflict
*
Your answer
Level of dependability, punctuality and attendance
*
Your answer
Rate this candidate as a potential team member.
*
Very weak
1
2
3
4
5
Very Strong
Would you recommend this candidate for a student trip?
*
Yes
No
Maybe
If no or maybe, please explain.
*
Your answer
Do you have any concerns you would like to share concerning this candidate and his/her suitability for a student trip?
*
Your answer
Date completed
*
MM
/
DD
/
YYYY
Send me a copy of my responses.
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