Reference Form

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Please print three copies of this form and give each to a person who will recommend you. 




Use Typewriter or black ink.


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 ______________________________________________________________


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.)