Parent/ Guardian/ Spiritual Parent - Confidential Reference Form

Name of Riza Applicant

Name of Person Filling Out This Form

Relationship to Applicant

This address will receive a confirmation email

Phone

The above named applicant is applying for admission to The Riza Experience in Corvallis, Oregon. The Riza Experience is a discipleship program with spiritual training and missions outreach aimed at equipping young Christian adults and challenging them to grow in their love for God, each other and the lost.

Please answer the following questions honestly and completely. It is important to us that we have a good understanding of our students and their needs so that we can build on their strengths and help them grow or heal in their areas of weakness.

1. Does the applicant know Jesus as their personal Lord and Savior and display Christ in everyday living? Explain.

2. Comment briefly on how the applicant responds to conflicts in relationships to authority.

3. Comment briefly on the applicant's family and social background. Is the family a healthy one? Does the applicant struggle because of any aspects of his/her past? If so, what?

4. What are the applicant's greatest strengths?

5. What are three areas you would like to see the applicant challenged to grow in this year?

6. Do you have any advice for working with the applicant's particular temperament, challenging them and bringing out their best?

7. To the best of your knowledge, has the applicant...

Been convicted of a felony?

Engaged in sexual misconduct in the last two years?

Been expelled/ dismissed from any school or college?

Experienced any sexual trauma, abuse and/or habits?

If you answered yes to any of the above questions, please explain.

8. Would you recommend the applicant for acceptance into The Riza Experience?

Please explain here, if applicable.

Evaluation of Applicant

Please select one description for each characteristic. If you have not observed this trait, choose "unknown". Consider the "average" to be a reasonably well-adjusted individual who is qualified for full-time Christian work.

Humility