Impact Internship Confidential Recommendation Form

Applicant Name Applicant Name * First Last
Please complete the recommendation and submit it. DO NOT RETURN THIS RECOMMENDATION TO THE APPLICANT.
Name Name * First Last
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone * - ### - ### ####
Email *
Please read the following before filling out this recommendation.

Serious consideration will be given to your evaluation of the applicant. We need to know as much as possible about our applicants to make fair appraisals for their qualifications matching all applicants with the best possible ministry opportunity for them. Your responses will be held in strict confidence. If you have any questions, please call 817-554-5900 ext:352 to speak with an Impact Student Ministries representative.
Relationship to the applicant (i.e youth pastor, teacher, friend) *
How long have you known the applicant? (must be at least one year) *
How well do you know the applicant? *

How well do you know the applicant? by Face/ Name Casually Fairly Well Very Well
Which of the following best describes the applicant?

SKILLS (1 is the lowest, 5 is the highest) *
	1	2	3	4	5
Adaptability	Adaptability1	Adaptability2	Adaptability3	Adaptability4	Adaptability5
Servanthood	Servanthood1	Servanthood2	Servanthood3	Servanthood4	Servanthood5
Dependability	Dependability1	Dependability2	Dependability3	Dependability4	Dependability5
Spiritual Life	Spiritual Life1	Spiritual Life2	Spiritual Life3	Spiritual Life4	Spiritual Life5
Maturity	Maturity1	Maturity2	Maturity3	Maturity4	Maturity5
Response to Authority	Response to Authority1	Response to Authority2	Response to Authority3	Response to Authority4	Response to Authority5
Spiritual Influence on Peers	Spiritual Influence on Peers1	Spiritual Influence on Peers2	Spiritual Influence on Peers3	Spiritual Influence on Peers4	Spiritual Influence on Peers5
Leadership Ability	Leadership Ability1	Leadership Ability2	Leadership Ability3	Leadership Ability4	Leadership Ability5

Please provide any other information you feel may be helpful: *
Based on the information above, the applicant is: *

Based on the information above, the applicant is: Strongly Recommended Recommended Recommended with Reservation Not Recommended
Signature *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Position *
Date Date * / MM / DD YYYY