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Counselor Reference
Counselors are required to provide three references. All people filling out references must be 21 years or older, a non-family member, and at least one reference must be from the pastor of the church they are attending.
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Indicates required field
Name of Prospective Counselor
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First
Last
How long have you known this person?
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In what capacity do you know this person?
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Has this person ever been convicted of a crime of which you are aware?
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YES
NO
If you answered YES to the above question, please explain:
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Is this person active in his/her local church?
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YES
NO
Does this person seem mature in handling discipline and authority?
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YES
NO
If your own child was placed in this person's cabin, would you feel comfortable?
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YES
NO
Have you observed this person interacting with children or youth?
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YES
NO
Do you have any comments or concerns about how this person interacts with children or youth?
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To the best of your knowledge, how long has this person been employed at their current place of employment?
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Would you recommend this person as a counselor without any reservations?
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YES
NO
Your Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Email
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Submit