REFERENCE FORM
Use Typewriter or black ink.
Waiver:
I waive the right to review reference responses
to this form.
Minister's Signature
_____________________________________ Dated:______________________
To the Reference: The person listed below
has given your name as a reference. Please complete this form and return it to Dayspring Ministries International. Neatness,
clarity and dark copy which will reproduce well are essential. If the waiver has been signed the information you put on the
form will be kept in confidence, but will be seen by the Board of Directors of DMI. Thank you for your assistance.
Please mail this form to: Dayspring Ministries
International
Dr. Gary Barkman, Presiding Archbishop
P.O. Box 3634, Brookhaven,
Mississippi 39603-7634 - Phone: 601-833-4559
Minister's Name ______________________________________________
Address ___________________________________________________________
Address 2 _________________________________________________________
Phone #'s _____________________________
E-Mail_______________________
_
Reference Name ____________________________________________________
Address __________________________________________________________
Phone #'s _____________________________
E-Mail_______________________
How Long have you known this person:_______________________
Relationship: ___ Lay member of present congregation
___
Lay member of previous congregation ___ Clergy
Colleague
___ Counselor / Therapist Colleague ___ Fellowship
/ Denominational Leader /
Staff ___ Family Friend
Other ______________________________________________________________
PERSONAL CHARACTERISTICS
Please place the appropriate number in the
blank following the personal characteristic:
1 Exemplary 2 Many Times 3 Sometimes 4 Do
Not Know
1. Follows through with responsibilities
___
2. Protects confidentially ___
3. Handles pressure well ___
4. Manages time wisely ___
5. Appropriate personal appearance
___
6. Likes people ___
7. Handles conflict well ___
8. Portrays Christian maturity ___
9. Takes criticism well ___
10. Takes praise graciously ___
11. Seeks help from others when needed ___
12. Takes time for study ___
13. Is creative/imaginative ___
14. Has a positive attitude ___
15. Is flexible/adaptable ___
16. Is a good listener ___
This person uses the following leadership
style (Rank 1, 2, 3)
___ Takes primary initiative and responsibility
___ Allows laity or to take primary
responsibility
___ Shares responsibility with laity
For what type of situation do you feel this
person best suited? _________________
___________________________________________________________________
Are there counseling or ministerial situations
for which it would be unwise to consider him/her?
_______________________________________________________________
__________________________________________________________________
Does this person maintain confidentiality;
being compassionate and sensitive to others needs; helping persons develop emotional maturity and security?
__________________________________________________________________
Does this person help persons develop
their spiritual life; encouraging persons to relate their faith to their daily lives?
___________________________________________________________
Does this person make calls on
persons in hospitals; ministering to persons in crisis situations?
___________________________________________________________
Are there other comments which would assist
Dayspring Ministries International in making a decision to certify or not certify this person? (Please limit your comments
to this and one other page.)
