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Discerners
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Planters
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Adoptions

VineyardUSA Church Adoption Reference Form

Name
First Last
Title/Position
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Consent
I authorize the release of all information relevant to the completion of this reference form.
Briefly describe your relationship to the applicant, how long you have known him/her, under what circumstances and how intimately.
What evidence do you see that the applicant is called to a senior pastorate (e.g. started campus Bible study, disciple-maker, pastoral ministry in the past)?
How would you rate the applicant's resiliency, both physically and emotionally for thriving in a potentially difficult environment (be specific about problems with health, depression, authority figures, etc.)?
- Not resilient for ministry
- Somewhat resilient
- Demonstrated resilience in the midst of challenges
- More than resilient enough for full time ministry
What do you see in the applicant's history that you would consider good preparation for pastoring (include special aptitudes or accomplishments)?
If the candidate is new to full time ministry, what do you sense may be lacking in the applicant's preparation?
How would you rate the applicant in counseling abilities?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in vision casting?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in gathering skills?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in team building for staff or other leaders??
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in administration?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in preaching?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in a classroom setting?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in a "one-on-one" discipling relationship?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in personal discipline in use of time and self-organization?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
How would you rate the applicant in managing personal finances?
- Excellent
- Very Good
- Good
- Fair
- Poor
- Not Observed
To what extent has the applicant's relationship been the catalytic event in the conversion of non-believers?
How frequently and how deeply have such relationships occurred?
Describe the kind of tasks for which you see the applicant well suited (e.g. what would you put him/her in charge of?).
What type of task(s) related to pastoral ministry do you think might be the most difficult for the applicant?
What have you observed about the applicant's stewardship?
Do you know of any significant indebtedness?
What have you observed of the applicant's personal fellowship or walk with God (including prayer life and use of Scripture)?
What have you observed of the applicant's family relationships (with spouse and children)?
Are you aware of any difficulties in the applicant’s family relationships that would impact his/her ability to be an effective pastor?
What is your opinion of the spiritual maturity of the applicant's spouse?
What is your opinion of the spiritual maturity of the applicant's children?
What have you observed of the applicant's response to disappointment, misunderstanding, sickness, or other difficult circumstances?
Comment on the applicant's teamwork and cooperation (e.g. works well with others, prefers to work alone, takes instruction willingly, etc.).
Comment on the applicant's willingness to serve (e.g. reluctant, too forward, assumes responsibility, consistently conscientious, etc.).
Comment on the applicant's work ethic.
The following problems are often evident in pastoral “drop-outs.” If any are perceived as a possible problem, rate between 1 (minor problem) to 5 (major problem).
Often preoccupied with worries of existence – money, accommodations, possessions
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
Difficulty living with authority or being accountable
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
Difficulty recognizing and empowering strengths in others
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
May have problems with spouse
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
May have problems with children
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
May need constant pastoral care and affirmation
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
Overly dependent on results for sense of accomplishment
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
May have difficulty in getting close to new people; doesn't often take the initiative in relationships
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
May not be sufficiently mature in feeding himself/herself on the Scriptures and walking with God sufficiently to pull through problems
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
Too little experience to know how to make disciples
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
Difficulty in team-building
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
Difficulty managing conflict
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
Too little self-esteem
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
Too little self-discipline
- Not a Problem
- 1 (minor problem)
- 2
- 3
- 4
- 5 (major problem)
How would you rate the applicant's potential for pastoral ministry?
- A rare find, ideal
- Exceptional
- Good potential
- Significant reservations
- Would definitely discourage

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