REFERENCE Reference Step 1 of 4 25% Name* First Last Address* 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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Enter Email Confirm Email ApplicantName of Applicant*What is your relationship to the applicant?*ParentTeacherPastorFriendPast YWAM LeaderEmployerOtherIf other please explainHow well do you know the applicant?* Very Well Well Casually How long have you known the applicant?* About the ApplicantPlease check the following and comment as necessary.Initiative*SuperiorAbove AverageAverageBelow AverageInferiorConcern for Others*SuperiorAbove AverageAverageBelow AverageInferiorSocial Adaptability*SuperiorAbove AverageAverageBelow AverageInferiorAbility to Follow*SuperiorAbove AverageAverageBelow AverageInferiorLeadership*SuperiorAbove AverageAverageBelow AverageInferiorJudgment/decision making*SuperiorAbove AverageAverageBelow AverageInferiorEmotional Stability*SuperiorAbove AverageAverageBelow AverageInferiorHealth*SuperiorAbove AverageAverageBelow AverageInferiorPersonal Appearance*SuperiorAbove AverageAverageBelow AverageInferiorComments* About the Applicant part IIMental Ability*Quick to comprehendAverageSlowIndustry*Hard workerAverageLacks persistenceReliability*Meets ObligationsAverageNeglects obligationsCooperativeness*Works well with othersAverageAvoids group activitiesFlexibility*Open to ChangeAverageUnyieldingChristian Character*Well balancedAverageUnstableDisposition*CheerfulAveragePassivePunctuality*PunctualAverageOften lateFinancial Responsibility*Honors obligationAverageNeglectfulComments* About the Applicant part IIITo what extent is the applicant active in church work?*Does he/she display high moral standards?*YesNoIf NO, please explain.Is he/she prejudice against groups, races or nationalities?*YesNoIf YES, please explain.With reference to his/her Christian service, is he/ she....?*DedicatedAverageCasualCommentsWhich of the following would best describe the applicant's Christian experience?*MatureContagiousGenuine and growingOver-emotionalSuperficialYou can check more than one.CommentsWhat do you consider to be applicant's strong points (including special abilities)?*Please comment on the applicant's family background (if known)?*In your opinion, what are the applicant's motives in applying to this program?*What could YWAM Upper Valley do to aid in the applicant's personal development?*Please add any other pertinent remarks that we should be aware of*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?*YesYes, with some reservationsNoPlease explain. 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