Reference Form for Applications

Thank you for taking time to provide this information. Catholic Christian Outreach Canada is a Catholic university student movement dedicated to evangelization. Individuals participating in CCO Mission Projects work closely with youth and other university students. A careful assessment of this applicant?s strengths and weaknesses, and his/her ability to serve as a Christian leader is critical to ensuring a successful and effective mission trip. All information given by you in this reference form will be held confidential, and not accessible to the applicant.

Applicant's Name:

Referent's Information:

Name:

Phone:

Email:

Age:

1. How long have you known the applicant and in what capacity?

2. To your knowledge, has the applicant ever been chemically dependent?

3. To your knowledge, has the applicant ever suffered from depression, eating disorders or suicidal tendencies?

4. To your knowledge, has the applicant ever been convicted of a criminal offense?

5. To your knowledge, has the applicant ever been charged with and found to have committed sexual harassment, sexual abuse or sexual exploitation?

6. Do you know of any reason why this person should not work with young people?

Please check all boxes that describe the applicant in the various areas below. Feel free to expand if the given answers are inadequate. Do not check items about which you feel uncertain or which you have had no opportunity to observe.

Attitude toward authority:

Involvement in a local parish:

Moral character:

Perseverance:

Emotional stability under stress:

Sociability or Friendliness:

Friendships/Relationships:

Teamwork (ability to work with others):

Response to Conflicts:

Level of spiritual maturity:

Leadership (ability to inspire others and maintain their confidence)

PART C Please check off any of the following characteristics or traits that you have noted in the applicant. Do not circle items which you feel uncertain about or which you have had no opportunity to observe.

PART D

1. Please elaborate on one of his/her most dominant strengths?

2. Please elaborate on one of his/her most dominant weaknesses?

3. Please comment on the applicant?s suitability to participate in this evangelistic mission project, where they will share their faith with others, be required to live in community, work with young people and others in parish communities.

Date:

Signature (enter your initials):

Protecting your Personal Information At Catholic Christian Outreach we recognize and respect every individual?s right to privacy. When you submit a reference for a mission project applicant we store it in a confidential file that is kept in the missions office of Catholic Christian Outreach. We use the information for the purposes of establishing, managing or terminating the project relationship. For CCO?s complete privacy policy see our website www.cco.ca. If you have any concerns regarding the privacy of your information you may contact our Privacy Officer in writing at privacy@cco.ca or 1247 Kilborn Place, Ottawa ON K1H 6K9