Under each general heading, check the phrase that most accurately describes the applicant's habitual behavior with regard to that specific trait.

How well is the applicant able to direct and influence others? *
How well does the applicant work with others? *
How does this person react to suggestions or criticisms by others? *
How does the applicant demonstrate a lifestyle committed to spiritual growth and integrity? *
How responsible is the applicant? *
How well does this person apply energy and persistence in completing a task? *
How well does the applicant control their emotions? *


With "1" as the lowest or poorest end of the scale and "10" as the highest or best, please select the number that best reflects this applicant.

Poor: 1-2, Average: 3-5, Good: 6-8, Superior: 9-10

Teachability *
Promptness *
Ability to Follow Instructions *
Outgoing *
Emotional Balance *
Ability to Work With Children *
Ability to Work With Youth *
Fulfilling Obligations *
Sense of Humor *
Temper Control *
Ability to Follow Through *
Ethusiasm *
Trustworthiness *
Ability to Get Along With Others *
Tactfulness *
Leadership Ability *
Friendliness *
Willingness to Serve Others *


Please briefly state specific instances in which you have observed the applicant's behavior as it applies to any of these items. If you lack personal knowledge on a given topic, please say so.

Please select one: *
Signature: *

If you have any further questions or concerns regarding this reference form, please call the office at (605) 343-4394 or email our Director, Ben Sutton, at

Thank you very much!

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