REVOLUTION HAWAII REFERENCE FORM

An individual applying for admission to Revolution Hawaii has listed you as a personal reference. Therefore, we request your cooperation in completing this form. All information will be held in strict confidence.

Applicant's First Name *

Applicant's Last Name *

REFERENCE INFORMATION

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Email Address *

Phone *

Is this a Personal or Pastoral Reference? *

Personal

Pastoral

PLEASE ANSWER THE FOLLOWING QUESTIONS

How long have you known the applicant? *

In what capacity do you know the applicant? *

How well do you know the applicant? *

Very Well	Well
Casually

Does the applicant know Christ as personal Savior and Lord? *

Yes	No
Unsure

Please describe: *

In your association with the applicant, what has been the level of commitment you have seen exemplified? *

Faithful	Inconsistent
Other Other

Describe the applicant’s leadership ability: *

Prefers to follow	Makes some effort to lead
Good ability	Exceptional ability

What are the applicant’s strong points (include special abilities)? *

Has the applicant had any serious problems in submitting to parental or other authority? *

Yes

No

Please comment: *

APPLICANT EVALUATION

Please rate the applicant in the following areas on a scale of 1 (lowest) to 5 (highest). *

	1	2	3	4	5
Ability to work hard	1	2	3	4	5
Self-confidence	1	2	3	4	5
Current involvement in ministry	1	2	3	4	5
Flexibility	1	2	3	4	5
Humility	1	2	3	4	5
Motivation to serve people in need	1	2	3	4	5
Passion for Justice	1	2	3	4	5
Sense of Humor	1	2	3	4	5
Teachability/openness to new ideas	1	2	3	4	5
Team Player	1	2	3	4	5
Ability to establish healthy relationships	1	2	3	4	5

Do you fully approve of the applicant participating in RevHI? *

Yes

No

Comments (Please describe any reservations or concerns): *

Please feel free to contact us if you have any further questions or comments 808-381-1242.

ELECTRONIC SIGNATURE

I have agreed to submit this reference form by electronic means. By signing this form electronically, I certify that my answers are correct and complete to the best of my knowledge.

Electronic Signature Agreement *

By checking this box and typing my name below, I am electronically signing my reference form.

Electronic Signature *