Student References Thank you for providing a reference for a student grant/scholarship applicant. Your Responses will be sent to BMDF.ORG and director Bob Thomas. Reference Form Student(Required)Name of the person for whom this reference is being submitted. First Last ABOUT YOUName(Required) First Last City and State(Required) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Phone(Required)Email(Required) ABOUT THE APPLICANTHow long have you known the applicant?(Required) How well do you know the applicant?(Required) In what capacity do you know the applicant?(Required) Are you aware of their willingness to share the Gospel?(Required) Based on your knowledge of the applicant, what skills and gifts do they possess that would be helpful in ministry?(Required)What are the areas in which the applicant has to grow?(Required)CHILD PROTECTIONAs a Christian Ministry, Baptist Medical Dental Fellowship upholds the highest standards for people serving with our organization and we strive to protect children and adults from abuse and mistreatment. 1) To your knowledge, has the applicant ever been accused of, engaged in, or shared with you about any inappropriate conduct with another person—be it a minor or another adult?(Required)Inappropriate conduct includes but is not limited to: threatening behavior, verbal or sexual harassment, unwanted advances, things such as real or virtual sexual activity with a minor, or racist speech. Yes No 2) To your knowledge, has anyone ever raised concerns about the applicant’s interactions with children?(Required)Children are individuals under the age of 18 years old. Yes No 3) To your knowledge, has anyone ever made an allegation that the applicant was in any way inappropriate with a child or children?(Required)Children are individuals under the age of 18 years old. Yes No 4) To your knowledge, has the applicant ever been accused of or charged with child abuse or a crime involving or related to a child or children?(Required)Children are individuals under the age of 18 years old. Yes No 5) To your knowledge, is there anything in the applicant’s past or present that would hinder the applicant in any way from effectively ministering with children or youth?(Required)Children are individuals under the age of 18 years old. Yes No 6) Do you have any concerns about the applicant and how he/she interacts with children?(Required)Children are individuals under the age of 18 years old. Yes No 7) Have you observed the applicant interacting with a child or children?(Required)Children are individuals under the age of 18 years old. Yes No 8) If applicable, would your organization have the applicant back in the future to work with children.(Required)Children are individuals under the age of 18 years old. Yes No Not Applicable You answered No. Please explain.SUMMARY/RECOMMENDATIONS10) Based on what you know about the mission opportunity how would you rate the applicant, on a scale 1-10, as a good fit for this opportunity?(Required)1=Not a good fit for this opportunity10=A very good fit for this opportunityChoose a Rating1234567891011) Is there any additional information you think we need to know to help us make wise decisions in providing a scholarship to this student for his/her upcoming mission trip?(Required)Signature: Typing in your name will act as your signature.(Required) Today's Date(Required) Month Day Year
