Clone of Reference Form: Internship

Maison Mission Trip Refernce Form

The named applicant is attending a Mission Trip at Maison des Enfants de Dieu in Port au Prince, Haiti. Maison is an orphange for over 100 children in Haiti. You can read more about Maison at forhisgloryoutreach.org. This forms is to be filled out by a pastor or other spiritually mature Christian individual who knows the applicant well enough to accurately answer the questions below. All information in this form will be seen only by our director and program leader(s) and never by the applicant.
Applicant's Name

First Name Last Name
Your Full Name

First Name Last Name
Birth Date

Month Day Year
Organization that you represent:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
E-mail
Are you a believer in Jesus Christ?
Are you committed to a local church?
Name of your church:
How long have known the applicant?
Have you been involved with or witnessed the applicant in any Christian ministry roles?
Please consider the following items in the life of the applicant. Rank each from 1-5. 1= "not present in the applicant's life" and 5= "extremely present in the applicant's life."
Honesty and Transparency
Neat and Clean Personal Appearance
Positive and Mature Reaction to Stress
Servant's Heart
Punctuality
Self Motivation
Ability to Work without Supervision
Mature Understanding of God's Character
Submissive to Authority
Ability to be Flexible
Comfort Level in being Assertive when Giving Directions, Reprimands, and Praises
Signature

Clear
Should be Empty:

Maison Mission Trip Refernce Form

Please consider the following items in the life of the applicant. Rank each from 1-5. 1= "not present in the applicant's life" and 5= "extremely present in the applicant's life."