Full Name* First Name Last Name Email* Phone Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Applicant you are referencing* First Name Last Name Email address of applicant you are referencing* Your relationship to the applicant* Pastor Youth Pastor Employer Friend Co-Worker Mother Father Brother Sister Aunt Uncle Rate each of the following:1 (poor) - 5 (excellent) or Unknown. Note: These are not judgment statements, but ratings based on your observations and interactions with the applicant.Ability to disciple and mentor others* 1 2 3 4 5 Unknown Administration and Organization* 1 2 3 4 5 Unknown Christian witness in the community* 1 2 3 4 5 Unknown Conduct with the opposite sex* 1 2 3 4 5 Unknown Conflict resolution* 1 2 3 4 5 Unknown Dependability* 1 2 3 4 5 Unknown Emotional stability* 1 2 3 4 5 Unknown Evidence of the fruit of the Spirit* 1 2 3 4 5 Unknown Freedom from sin and addictions* 1 2 3 4 5 Unknown Home environment* 1 2 3 4 5 Unknown Industriousness and work ethic* 1 2 3 4 5 Unknown Leadership skills* 1 2 3 4 5 Unknown Mercy for the hurting and needy* 1 2 3 4 5 Unknown Relating to people from other cultures* 1 2 3 4 5 Unknown Sensitivity to others* 1 2 3 4 5 Unknown Social and relational skills* 1 2 3 4 5 Unknown Willingness to serve* 1 2 3 4 5 Unknown Comments*Applicant's effect on community* Builds Loves and lives within it Drains energy from Damages or destroys Applicant's relationship to authority* Appreciative of input and guidance Quiet submission Begrudging obedience Resentful or rebellious Describe one area in which you have seen growth in the personal character of the applicant over the last year.*Rate each of the following:1 (not a problem) - 5 (serious concern) or Unknown. Note: These are not judgment statements, but ratings based on your observations and interactions with the applicant.Careless* 1 2 3 4 5 Unknown Critical* 1 2 3 4 5 Unknown Depressed* 1 2 3 4 5 Unknown Divisive* 1 2 3 4 5 Unknown Easily embarrassed* 1 2 3 4 5 Unknown Easily offended* 1 2 3 4 5 Unknown Immature* 1 2 3 4 5 Unknown Impatient* 1 2 3 4 5 Unknown Impulsive* 1 2 3 4 5 Unknown Intolerant* 1 2 3 4 5 Unknown Moody* 1 2 3 4 5 Unknown Prejudiced* 1 2 3 4 5 Unknown Proud* 1 2 3 4 5 Unknown Selfish* 1 2 3 4 5 Unknown Worried* 1 2 3 4 5 Unknown Comments*Relates best with (multiple selections are fine): Children Teens Adults Not sure Other (explain in comments) Applicant's interest in missions*Short-termLong-termNot sureHas the applicant been involved in abusive relationships, as a victim or an abuser?*YesNoUnknownHow likely would you be to hire the applicant to serve with your mission? (1 being unlikely, 5 being very likely)* 1 2 3 4 5 Best time/days to call (if necessary)* CommentsDo you know others who might appreciate more information about the Ministry Training Center? If so, please list their names and contact information below.After you click "Submit" you will receive an email confirmation and be redirected to our web page about the Long Term Orientation.HiddenLTO or Intern Reference (Hidden Field) HiddenReference Record Type (HIdden Field)