Reference FormStep 1 of 425%YWAM Madison ReferenceApplicant who requested this reference:(Required) First Last Program or position applicant is applying for (if known):(Required) DTS (Discipleship Training School) FMI (Foundations for Missions Internship) BSN (BIble School for the Nations) SBCW (School of Biblical Christian Worldview) LCA (Living Christian Apologetics) DTS Equip Mission Adventures YWAM Madison Staff Volunteer OtherYour Contact InformationYour Name(Required) First Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone(Required)Email(Required) Send me occasional updates about the program the applicant is involved in.(Required) Yes NoRelationship to ApplicantRelationship to Applicant(Required)Pastor or Spiritual LeaderTeacher or EmployerYWAM LeaderParent / Legal GuardianFriendHow long have you known the applicant?(Required)On a scale of 1-5, how well do you know the applicant?(Required)1 (Very little)2345 (Very well)1 being very little, 5 being very well.Your ChurchYour Church Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Your Church Website Your YWAM CampusYWAM Campus Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country YWAM Website What do you consider to be the applicant's strengths?(Required)How would you describe the applicant's relationship with the Lord?(Required) Inconsistent Lack’s depth Genuine and growing Contagious Dynamic Mature Not observedLeadership, Teamwork, and Problem SolvingA YWAM missionary must be able to accommodate to unaccustomed living conditions and new social situations. Adjustments may have to be made as to diet, social customs, climate changes, etc. Keeping in mind the challenge of these unusual demands, please answer the following questions.Flexibility(Required) Inflexible Average Open to change Not observedAchievement (ability to formulate, execute and complete plans)(Required) Starts but doesn’t finish Does only what’s asked Meets average expectations Superior creative ability Not observedIs the applicant usually punctual?(Required) Yes No Not observedReliability(Required) Neglects obligations Average Meets obligations Not observedTeamwork(Required) Often causes friction Usually cooperative Works well with others Not observedCan he or she organize others?(Required) Yes No Not observedLeadership (ability to inspire others and maintain their confidence)(Required) Makes no effort to lead Tried but lacks ability Has leadership promise Unusual ability to lead Not observedLeadership PotentialListed below are some of the qualities which describe a leader. Please rate the Applicant in all the categories that you have observed, and if you have not, mark “Not Observed”.Positive Attitude(Required) Weak Developing Average Mature Strong Not ObservedRespect for others' opinions(Required) Weak Developing Average Mature Strong Not ObservedTeachable Attitude(Required) Weak Developing Average Mature Strong Not ObservedAbility to make decisions clearly(Required) Weak Developing Average Mature Strong Not ObservedAbility to deal with interpersonal problems(Required) Weak Developing Average Mature Strong Not ObservedSelf-confidence(Required) Weak Developing Average Mature Strong Not ObservedAbility to communicate clearly(Required) Weak Developing Average Mature Strong Not ObservedAbility to receive criticism(Required) Weak Developing Average Mature Strong Not ObservedSocial poise(Required) Weak Developing Average Mature Strong Not ObservedHow do you think the Applicant will respond to living in community with people from different cultures, age groups, church denominations, etc? What will be his or her greatest strength and challenge in this living environment?(Required)Can he or she solve problems creatively?(Required) Yes No Not ObservedTemperamentIn your opinion the applicant is (check all that apply):(Required) Thoughtful Quiet Stubborn Nervous Reserved Follows Stern Independent Bossy Shy Sloppy Diligent Neglects Overly sensitive Lazy Outgoing Reliable Loving Moody Careless Friendly Bold Outspoken Considerate Dramatic Helpful Encourager Industrious Flexible Inflexible Forgets Clumsy Enjoys responsibility FearfulHow does he/she take constructive criticism?(Required) Feels hurt Rebels Accepts with thanks Initially rejects, but learns Not observedWillingness to serve:(Required) Reluctant to serve Motives confused Eager to serve as needed Not observedResponsiveness to the feelings and needs of others:(Required) Slow to sense how others feel Reasonably responsive Understanding and thoughtful Unusually responsive Not observedListed below are some of the tendencies, which if present, may reduce the effectiveness of a YWAM missionary. Please select words or descriptions that pertain to the Applicant:(Required) Impatient Argumentative Critical of others Easily offended Frequently worried Frequently nervous or tense Prejudiced towards groups, races, or nationalities Unable to cope with stress Intolerant Domineering Easily embarrassed Easily discouraged Frequently anxious Given to moodiness or mood swings Lacking in humor, or in the ability to take a joke Erratic in attitudes or actions The Applicant sees relatively free from all such tendenciesIf you have noted any of these or similar limitations in the Applicant's life, please elaborate:OtherJust a few final miscellaneous questions before we finish!Is he or she actively involved in a church?(Required) Yes No Not surePhysical condition:(Required) Frequently incapacitated Fairly healthy/average Good health Not observedFinancial responsibility:(Required) Neglectful Average Honors obligations Unsure/not observedPlease comment on your choices:Check any of the following which you feel are motivating the Applicant to become part of YWAM:(Required) Christian service Escape an unpleasant home situation Receive help, ministry, and discipleship Desire to spread the Gospel Desire to help others Travel Adventure Other UnknownPlease comment on what you know of the applicant's family background:(Required)Please choose any that apply, to the best of your knowledge(Required) The Applicant has proven on occasion to be unreliable, dishonest, or of questionable character The Applicant has been arrested for any offense other than minor traffic violations The Applicant has been involved in drug/alcohol abuse None apply Unknown/unobservedIf one or more of the above were selected, please explain:What is your overall evaluation of the Applicant's promise as a YWAM worker?(Required) Definitely unsuited At this time, I feel the applicant is not suited A good prospect, but I do have some reservations An average prospect An above average prospect An unusually exceptional prospectIf you have reservations about their suitability, please elaborate:What is your recommendation for the applicant?(Required) To be accepted Not to be acceptedIs your recommendation:(Required) Strong Hesitant WeakDo you have any other further comments or requests?
