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Children’s Institute Reference Questionnaire

Thank you for taking the time to fill out this reference form.

Your Name(Required)

First Last

Email(Required)

Primary Phone(Required)

Secondary Phone

Please affirm that you are 18 years of age or older(Required)

Yes

No

Applicant name you are filling out the reference form for(Required)

First Last

How do you know the applicant?(Required)

How long have you known the applicant?(Required)

On a scale of 1-10 (with 10 being the highest), how well do you know the applicant?

Please elaborate on your answer above:(Required)

How would you rate this person's growth as a believer?(Required)

Excellent

Above average

Average

Below average

Poor

What evidence have you seen for your answer above?(Required)

Concern for others(Required)

Always puts others' needs above their own

Mostly puts others' needs above their own

Rarely notices others' needs

Unsure

Self-motivation(Required)

Very self-motivated

Motivated, but occasionally needs outside influence

Expresses interest but needs mostly outside influence

No motivation, constantly needs outside influence

Leadership capability(Required)

Good

Assumes occasional leadership

Tries but usually fails at leadership

Always follows

Unsure

Willingness to follow instructions(Required)

Is willing to follow even when personal opinion is different

Mostly follows but tries to input personal opinion

Sometimes follows but with a negative attitude

Usually adheres to personal opinion above given instruction

Self-discipline(Required)

Accomplishes tasks without outside management

Mostly does well, but needs management once in a while

Constantly needs management and supervision

Unsure

Ability to cope with stress(Required)

Does well even when stressed

Survives, but has difficulty making it through

Is unable to finish a task when under stress

Punctuality(Required)

Always on time, if not early

Mostly on time

Often late

Always late

Unsure

Cooperation(Required)

Excellent in regards to working with others

Mostly gets along with others

Struggles with working with others

Tends to go their own way

Unsure

Additional Comments

A ministry of IBLP

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