REFERENCE Reference Step 1 of 4 25% Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Phone(Required)Email(Required) Enter Email Confirm Email ApplicantName of Applicant(Required) What is your relationship to the applicant?(Required)ParentTeacherPastorFriendPast YWAM LeaderEmployerOtherIf other please explain How well do you know the applicant?(Required) Very Well Well Casually How long have you known the applicant?(Required) About the ApplicantPlease check the following and comment as necessary.Initiative(Required)SuperiorAbove AverageAverageBelow AverageInferiorConcern for Others(Required)SuperiorAbove AverageAverageBelow AverageInferiorSocial Adaptability(Required)SuperiorAbove AverageAverageBelow AverageInferiorAbility to Follow(Required)SuperiorAbove AverageAverageBelow AverageInferiorLeadership(Required)SuperiorAbove AverageAverageBelow AverageInferiorJudgment/decision making(Required)SuperiorAbove AverageAverageBelow AverageInferiorEmotional Stability(Required)SuperiorAbove AverageAverageBelow AverageInferiorHealth(Required)SuperiorAbove AverageAverageBelow AverageInferiorPersonal Appearance(Required)SuperiorAbove AverageAverageBelow AverageInferiorComments(Required) About the Applicant part IIMental Ability(Required) Quick to comprehend Average Slow Industry(Required) Hard worker Average Lacks persistence Reliability(Required) Meets Obligations Average Neglects obligations Cooperativeness(Required) Works well with others Average Avoids group activities Flexibility(Required) Open to Change Average Unyielding Christian Character(Required) Well balanced Average Unstable Disposition(Required) Cheerful Average Passive Punctuality(Required) Punctual Average Often late Financial Responsibility(Required) Honors obligation Average Neglectful Comments(Required) About the Applicant part IIITo what extent is the applicant active in church work?(Required)Does he/she display high moral standards?(Required) Yes No If NO, please explain.Is he/she prejudice against groups, races or nationalities?(Required) Yes No If YES, please explain.With reference to his/her Christian service, is he/ she....?(Required) Dedicated Average Casual CommentsWhich of the following would best describe the applicant's Christian experience?(Required)MatureContagiousGenuine and growingOver-emotionalSuperficialYou can check more than one.CommentsWhat do you consider to be applicant's strong points (including special abilities)?(Required)Please comment on the applicant's family background (if known)?(Required)In your opinion, what are the applicant's motives in applying to this program?(Required)What could YWAM Upper Valley do to aid in the applicant's personal development?(Required)Please add any other pertinent remarks that we should be aware of(Required)i.e. medical, psychological, drug or alcohol about, criminal record, homosexual or occultic practices, etc.Do you recommend the applicant for acceptance to this YWAM program?(Required) Yes Yes, with some reservations No Please explain. 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