Year 13 Personal Reference
Thank you for taking the time to complete this reference form for the prospective Year 13 student.  We ask that you complete this form honestly and to the best of your ability.  We appreciate your prompt attention to this as delays may slow the applicant's interview process.

This reference form must be completed by a person who is 25 years or older.  If this is not you, please ask the applicant to have it completed by someone else.
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Year 13 Applicants Name *
Your name *
Phone Number *
Email *
Do you attend Church? *
If YES, which one
Are you 25 years or older? *
How long have you known the applicant and in what capacity? *
Are you convinced that the applicant is converted to Christ? *
Briefly describe how their conversion is evident to you *
Please list what you believe to be the applicant’s top three areas of personal / spiritual strength. Briefly describe how the applicant has demonstrated these strengths.
Strength One *
Strength Two *
Strength Three *
What is an area of weakness that you would like to see the applicant grow in? *
Do you consider that the applicant has the temperament, interest and ability to undertake this program? *
If NO, please explain
As far as you are aware does the applicant have any illness, injury, disability (physical or mental), impairment or long-term medical condition which may affect their ability to carry out the requirements of the Year 13 program? *
If YES, please explain so that these may be explored in the interview process to ensure Year 13 can fulfil its duty of care towards the applicant
As far as you are aware is there or has there been any misconduct or inappropriate behaviour toward children or young people displayed by the applicant? *
If YES, please explain
Do you have any other comments or feedback regarding the applicant? *
If YES, please explain
Would you like a member of the Year 13 team to contact you before interviewing the student to follow up on this reference? *
Are you content for us to call you if we feel the need? *
Declaration *
Required
PRIVACY COLLECTION STATEMENT Anglican Youthworks respects your privacy.  We collect and use personal information to support our Christian ministry programs, which seek to assist and nurture children, youth and adults. You have the right to access the personal information we hold about you, with the exception of information gathered in relation to child protection issues. If you would like additional information about our approach to privacy or would like to access your personal information, you can contact our Privacy Compliance Officer, by email at privacy@youthworks.net
After submitting this application, make sure you are forwarded to a successful submission page. However if you receive a blank page, the application was NOT successfully submitted. Please contact us on (02) 8093 3412
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