RECOMMENDATION FORM
Print
two copies of this form and give to two persons who will recommend you
You
may fax this signed reference form
Use
Typewriter or black ink.
Waiver:
I, ________________________________ (applicant) hereby waive the right to review reference responses to this
form.
Applicant’s
Signature (required).
______________________________________________________________________________
To the Reference: The person identified above has given your name as a reference. Please complete this form
and return to AFS FAMILY SKILLS INSTITUTE within TWO WEEKS. Neatness, clarity and dark copy which will reproduce well are
essential. If the waiver has been signed the information you put on the form will be kept in confidence, but will be seen
by the Board of Directors of AACT. Thank you for your assistance.
Please
mail this form to:
AACT - AFS FAMILY SKILLS INSTITUTE
P.O. BOX 143
Tolar, TX 76476
Reference
Ministers/Therapists Name ______________________________________
Address
_____________________________________________________________
City:
_________________________ State: _____ Zip Code: __________________
Phone
/ E-mail __________________/____________________________
How
Long have you known this person: __________________________
Relationship:
___ Lay member of present congregation
___ Lay member of previous congregation
___ Clergy Colleague
___ Counselor / Therapist Colleague
___ Fellowship / Denominational Leader / staff
___ Family Friend
___ Other _______________________________
PERSONAL
CHARACTERISTICS
Please
place the appropriate number in the blank following the personal characteristic:
1
Exemplary 2 Many Times 3 Seldom 4 Do Not Know
_____ 1
Follows through with responsibilities
_____ 2
Protects confidentially
_____ 3
Handles pressure well
_____ 4
Manages time wisely
_____ 5
Appropriate personal appearance
_____ 6
Likes people
_____ 7
Handles conflict well
_____ 8
Portrays Christian maturity
_____ 9
Takes criticism well
_____ 10
Takes praise graciously
_____ 11
Seeks help from others when needed
_____ 12
Takes time for study
_____ 13
Is creative/imaginative
_____ 14
Has a positive attitude
_____ 15
Is flexible/adaptable
_____ 16
Is a good listener
This
person uses the following leadership style (Rank 1, 2, 3)
___
Takes primary initiative and responsibility
___
Allows laity or associates to take primary responsibility
___
Shares responsibility with laity or associates
For
what type of situation do you feel this person best suited?
Are
there counseling or ministerial situations for which it would be unwise to consider him/her?
In
this persons counseling, does he/she maintain confidentiality; being compassionate and sensitive to others needs; helping
persons develop emotional maturity and security?
In
this persons counseling, does he/she help persons develop their spiritual life; encouraging persons to relate their faith
to their daily lives?
In this persons counseling, does he/she make calls on persons in hospitals; ministering to persons in crisis
situations?
Are there other comments which would assist AFS Family Skills Institute and the American Association of Christian
Therapists in making a decision to certify or not certify this person? (Please limit your comments to this and one other page)
Signature
______________________________________ Date _________________
This
form is provided by the American Association of Christian Therapists, Granbury, Texas, 2002
PRINT
TWO (2) COPIES AND GIVE TO YOUR REFERENCES
HAVE
THEM SEND THE FORM DIRECTLY TO AACT
AACT
P.O.
Box 143
Tolar,
TX 76476 U.S.A.
OFFICE
NUMBER: 817-736-3041
or
Dr. Barkman's Cell: 817-219-7007
Ask
our receptionists for a catalog or packet ...
Call
between 9 AM & 5 PM Monday Through Friday...
Or
call anytime and leave a voice-mail.
You
may fax your application and all supporting documents
E-mail: aact@myway.com or:
aactonline@yahoo.com