DHM Scholarship Reference Form Date * Reference for (applicant name): * Please provide a short paragraph (no more than 150 words) describing the applicant’s potential for ministry: * Demonstrates creativity: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Demonstrates initiative: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Takes personal responsibility: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Shows sound judgment: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Has realistic goals: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Demonstrates motivation toward goals: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Logic and clarity: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement General character: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Comments regarding applicant’s personal and character skills: Interacts well with others: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Is respectful to others: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Receives respect from others: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Demonstrates leadership abilities: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement General relational skills: * 4 – Excellent 3 – Good 2 – Adequate 1 – Needs improvement Comments regarding applicant’s relational skills: Relationship to applicant: (PLEASE choose the option for the category for which YOU are filling out the reference form) * Pastor of Congregation Professor Regional Minister or Chair of Commission on Ministry Region * General Commission on Ministry (GCOM)Christian Church in Alabama and Northwest FloridaChristian Church in ArizonaChristian Church of Northern California-NevadaChristian Church of the Pacific SouthwestChristian Church in CanadaCentral Rocky Mountain RegionChristian Church in FloridaChristian Church in GeorgiaThe Great River RegionChristian Church South IdahoChristian Church in Illinois and WisconsinChristian Church in IndianaChristian Church in the Upper MidwestChristian Church in KansasChristian Church of Greater Kansas CityChristian Church in KentuckyChristian Church MichiganChristian Church of Mid-AmericaChristian Church in NebraskaChristian Church – Northeastern RegionChristian Church – Northern Lights RegionChristian Church in North CarolinaChristian Church in OhioChristian Church in OklahomaChristian Church in OregonChristian Church in PennsylvaniaChristian Church in South CarolinaChristian Church in TennesseeChristian Church in the SouthwestThe Christian Church in VirginiaChristian Church Capital AreaChristian Church in West VirginiaChaplains Office Is this student under the care of your region? * Yes No If no, is this student in the process of coming under the care of your region? * How long has this student been a member of your church? * Has this person been a student in a class you’ve taught? * Yes No Your name: * Address: * City: * Country * State/Province * Postal code: * Email * Phone * If you are human, leave this field blank.
