Alumni
Blog
Store
Staff
Give
About
Our Story
National Leadership
Area Leadership
District Leadership
Events
Resources
Get Involved
Join XA Staff
XA Diversity
feedONE
Worldwide Chi Alpha
XA Expeditions
XA Internationals
Group Locator
CMIT Applicant Character Reference Form
All references must be submitted by April 1.
Applicant's Name
*
First
Last
Applicant's Email
*
As a courtesy, we will send the applicant a notification email once your reference is submitted. He or she will not see the reference itself.
Applicant's First Choice Program
*
We will send a copy of the reference to the CMIT director of the applicant's first choice program. The first choice program is mentioned in the email sent to you, so please refer to that to fill in this field.
Angelo State University
Arkansas Tech University
Auburn University
Austin Peay State University
Ball State University
Baylor University
California State University-Sacramento
California State University-Stanislaus
Carol College
Central Washington University
Colorado State University
Columbia College Chicago
Dayton Chi Alpha / Wright State University
Eastern Michigan University
Edinboro University of Pennsylvania
Fairmont State University
Florida Gulf Coast University
Hendrix College
Idaho State University
Indiana University
James Madison University
Longwood University
Louisiana State University
Louisiana Tech University
Loyola University Chicago
McNeese State University
Missouri State University
New Mexico State University
Nicholls State University
North Carolina State University
North Dakota State University/Minnesota State University-Moorhead
Northern Arizona University
Oklahoma State University
Purdue University
Rice University
Rowan University
Sam Houston State University
San Diego State University
St. Xavier University
Stanford University
Stephen F. Austin University
Texas A&M University
Texas A&M University-Corpus Christi
Texas A&M University-Kingsville
Texas Tech University
Troy University
Tulane University
University of Alabama
University of Alaska-Anchorage
University of Alaska-Fairbanks
University of Arkansas
University of Arkansas-Little Rock
University of California, Santa Cruz
University of California-Davis
University of California-Merced
University of Central Arkansas
University of Houston
University of Idaho
University of Illinois-Chicago
University of Louisiana-Lafayette
University of Michigan-Ann Arbor
University of Minnesota-Duluth
University of Mississippi
University of Northern Colorado
University of North Dakota
University of Northern Iowa
University of North Texas
University of South Carolina
University of Tennessee
University of Texas at Austin
University of Texas at San Antonio
University of Texas Rio Grande Valley
University of Vermont
University of Virginia
Utah Valley University
Virginia Commonwealth University
Virginia Tech University
West Virginia University
Western Washington University
Winona State University
Yale University
Instructions: The above named applicant is applying for a ten-month, Campus Missionary-in-Training (CMIT) internship program with Chi Alpha Campus Ministries, U.S.A. and is asking for a reference from you. Your frank evaluation is appreciated.
Your Name
*
First
Last
Your Position/Title
*
Your Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Your Phone Number
*
Your Email
*
How do you know the applicant?
*
How long have you known the applicant?
*
Evaluation
How would you rate the applicant in the following qualities using the following key to evaluate? Please comment.
1 = No Observation
2 = Below Average
3 = Average
4 = Very Good
5 = Exceptional
Analytical ability, good judgment, thinks strategically
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's analytical ability, good judgment, and strategically thinking.
Willing to make decisions
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's willingness to make decisions.
Self-confident, self-assured
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's self-confidence and self-assurance.
Integrity in word and deed
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's integrity in word and deed.
Honest, truthful, non-deceitful
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's honesty, truthfulness, and non-deceitfulness.
Open with peers and overseers
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's openness with peers and overseers
Verbal communication skills
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's verbal communication skills.
Work habits, prompt, thorough
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's work habits, promptness, and thoroughness.
Emotional stability
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's emotional stability.
Desires to lead
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's desire to lead.
Willing to assume responsibility
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's willingness to assume responsibility.
Ability to get along with others
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's ability to get along with others.
Attitude towards authority
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's attitude towards authority.
Gains cooperation from others
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's gains in cooperation from others.
Sets challenging personal goals
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's personal goals.
Takes initiative, is proactive
*
1 - No Observation
2 - Below Average
3 - Average
4 - Very Good
5 - Exceptional
Comment on the applicant's initiative and proactiveness.
What is your assessment of the applicant’s fitness and suitability for working with a religious organization? Please state your estimation of the applicant’s character, capacity and motivation for vocational ministry.
*
Do you have any reservations regarding the applicant’s fitness and suitability for working with a religious organization?
*
Recommendation
*
I highly recommend this applicant.
I recommend this applicant to an internship-training program.
I do not recommend this applicant to an internship-training program.
CAPTCHA
Δ
Find A Chi Alpha Group Near You